S2k-Leitlinie Qualitätsanforderungen in der gastrointestinalen Endoskopie, AWMF Register Nr. 021–022

Kap. 1 Leitlinienreport

1.1 Geltungsbereich und Zweck

Auswahl des Leitlinienthemas

Zur Sicherung der Qualität endoskopischer Untersuchungen müssen Qualitätsstandards definiert werden. Eine entsprechende Qualitätssicherungsvereinbarung wurde zuletzt 2002 durch die KBV formuliert. Eine interdisziplinäre Leitlinie, die sektorenübergreifend die Standards für die gastroenterologische Endoskopie definiert, existiert bisher nicht.

Zielorientierung der Leitlinie

Die Leitlinie definiert notwendige Voraussetzungen zur Verbesserung der Strukturqualität im Hinblick auf die technische, räumliche und personelle Ausstattung von Endoskopieeinheiten. Zur Verbesserung der Prozessqualität werden Empfehlungen zur Patientenvorbereitung, zur Dokumentation und Zeiterfassung sowie zur Hygiene und Aufbereitung gegeben. In weiteren Kapiteln werden die Standards für spezielle endoskopische Prozeduren incl. Kontraindikationen, prozessbezogene Nachsorge und Komplikationen festgelegt.

Patientenzielgruppe, Versorgungsbereich und Anwenderzielgruppe

Die Leitlinie gibt Empfehlungen für Erwachsene, die sich einer endoskopischen Untersuchung unterziehen müssen.

Sie gilt sowohl für ambulant als auch für stationär durchgeführte Endoskopien sowie für den primärärztlichen und der spezialfachärztlichen Bereich.

Die Leitlinie richtet sich an alle Endoskopie tätigen Gastroenterolgoen und Chirurgen sowie an Endoskopieassistenzpersonal.

1.2. Zusammensetzung der Leitliniengruppe und Beteiligung von Interessensgruppen

Die Leitlinie wurde federführend durch die Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) erstellt, die als Koordinatorin Frau Priv.-Doz. Dr. med Ulrike Denzer, Hamburg beauftragte. Frau Priv.-Doz. Dr. med. Petra Lynen-Jansen, DGVS-Geschäftsstelle, Berlin, stand bei methodischen Fragestellungen beratend zur Seite und übernahm organisatorische Aufgaben. Frau Dr. med. Monika Nothacker, AWMF, Berlin moderierte als neutrale Leitlinienexpertin die erste Konsensuskonferenz.

Bei der Verteilung der Themengebiete wurde auf eine für die klinischen Fragestellungen repräsentative Besetzung geachtet. Die für das Fachgebiet relevanten Fachgesellschaften wurden angeschrieben und gebeten, Mandatsträger für Ihre Organisationen zu benennen. Die Anmeldung der Leitlinie wurde am 23.10.2012 auf der Webseite der AWMF veröffentlicht, sodass weitere Fachgesellschaften/Vertreter sich zur Mitarbeit melden konnten. Experten und Anwender aus den verschiedenen Versorgungsstufen wurden berücksichtigt.

Als Patientenvertreterin wurde Frau S. In der Smitten als Mitglied der Deutsche Morbus Crohn/Colitis ulcerosa Vereinigung e. V in die Leitlinienarbeit eingebunden.

Folgende Fachgesellschaften und Institutionen waren an der Erstellung der Leitlinie beteiligt:

• Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten

  Mandatsträger:

  U. Denzer, Hamburg; A. Eickhoff, Hanau; S. Faiss, Hamburg; R. Jacobs, Ludwigshafen; M. Keuchel, Hamburg; A. May, Wiesbaden; T. Rösch, Hamburg; U. Rosien, Hamburg; U. Weickert, Heilbronn; T. Wehrmann, Wiesbaden

• Deutsche Gesellschaft für Endoskopie und Bildgebende Verfahren (DGE-BV)

  Mandatsträger: C. Jenssen

• Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Chirurgische Arbeitsgemeinschaft für Endoskopie und Sonografie (CAES)

  Mandatsträger: R. Mennigen, Münster; T. Vowinkel, Münster

• Berufsverband niedergelassener Gastroenterologen Deutschlands e. V. (bng)

  Mandatsträger: G. Moog, Kassel

• Deutsche Gesellschaft für Thrombose und Hämostaseforschung

  Mandatsträger: F. Langer, Hamburg

• Deutsche Gesellschaft für Endoskopie-Assistenzpersonal e. V. (DEGEA)

  Mandatsträger: U. Beilenhoff, Ulm

• Deutsche Morbus Crohn/Colitis ulcerosa Vereinigung e. V. (DCCV)

  Mandatsträger: S. In der Smitten, Berlin

P. Baltes, Hamburg, K. Fraedrich, Hamburg, A. Gaus, Hamburg, B. Hartmann, Ludwigshafen und M. Jung, Mainz wurden als weitere Experten bei der Erstellung der Beiträge eingebunden.

Für das Kapitel Aufklärung erfolgte eine juristische Beratung durch Dr. P. Hüttl, Rechtsanwaltskanzlei Dr. Heberer & Kollegen München, die allerdings an der Abstimmung der Empfehlungen nicht teilnahmen.

1.3. Methodologische Exaktheit

Schlüsselfragen, Literaturrecherche und Auswahl der Evidenz

Auf einem initialen Treffen der Leitliniengruppe im April 2012 wurden die Themengebiete festgelegt. Die Mitglieder der Leitliniengruppe wurden entsprechend ihrer fachlichen Qualifikation und/oder der interdisziplinäre Notwendigkeit diesen Themengebieten zugeordnet und waren sowohl für die Literaturrecherche als auch für die Formulierung der Empfehlungen und Kommentare verantwortlich. Die erweiterte Literatursuche erfolgte in Pubmed und Cochrane databases. Weitere Artikel und Studien konnten bei Bedarf mit einbezogen werden.

Alle Suchergebnisse sowie alle relevanten Publikationen im Volltext wurden über ein webbasiertes Leitlinienportal der Leitliniengruppe zur Verfügung gestellt.

Die Evidenz wurde auf der Konsensuskonferenz diskutiert und bewertet.

Neue Literatur konnte bis zum Termin der abschließenden Konsensuskonferenz im Dezember 2014 berücksichtigt werden.

Formulierung der Empfehlungen und strukturierte Konsensfindung

Auf Grundlage der Literatur wurden die Empfehlungen durch die jeweiligen Autoren erarbeitet. Eine Graduierung der Empfehlungen erfolgte über die Formulierung soll, sollte, kann ([Tab. 1]). Alle Empfehlungen wurden in einem Delphiverfahren von allen Leitlinienmitarbeitern mithilfe einer 3-stufigen Entscheidungsskala abgestimmt (ja, unentschieden, nein). Hierzu wurden 3 Delphiverfahren im Januar, Juli/August und Oktober 2015 durchgeführt, denen die Empfehlungen themenspezifisch zugeordnet wurden. Zu Empfehlungen, die nicht mit ja abgestimmt wurden, musste ein begründender Kommentar hinterlegt werden. Empfehlungen, die zu über 95 % mit ja abgestimmt wurden, wurden bereits zu diesem Zeitpunkt verabschiedet ([Tab. 2]).

Tab. 1 Schema zur Graduierung von Empfehlungen. Negative Empfehlungen werden entsprechend formuliert.

Syntax	Beschreibung
soll	starke Empfehlung
sollte	Empfehlung
kann	Empfehlung offen

Tab. 2 Konsensfindung.

Konsens	% Zustimmung
Starker Konsens	> 95
Konsens	> 75 – 95
mehrheitliche Zustimmung	50 – 75
kein Konsens	< 50

Die Kommentare und Änderungsvorschläge der Delphirunde wurden von der Koordinatorin und dem jeweiligen Autor des Kapitels gesichtet und ausgewertet. Alle Empfehlungen, die in der ersten Abstimmung weniger als 95 % Zustimmung erhalten hatten, wurden überarbeitet und auf einer Konsensuskonferenz (siehe 3.3) erneut diskutiert. Nutzen und nebenwirkungsrelevante Outcomes wurden besonders berücksichtigt. Die erste Konsensuskonferenz wurde durch Frau Dr. med. M. Nothacker, AWMF, die zweite Konsensuskonferenz durch Priv. Dr. med. P. Lynen Jansen als neutrale Leitlinienexpertin moderiert. In einem nominalen Gruppenprozess wurden Änderungsvorschläge gesammelt und dokumentiert und anschließend eine finale Version im Plenum mittels TED-System abgestimmt. Das Ergebnis der Abstimmung wurde dokumentiert und die Konsusstärke gemäß [Tab. 2] festgelegt. Im Anschluss an die Konsensukonferenz erfolgte die finale Überarbeitung der Kommentare durch die Autoren der Kapitel und die redaktionelle Zusammenstellung der Leitlinie durch die Koordinatorin.

Tab. 3 Zeitplan.

Oktober 2011	Ausschreibung der Leitlinie in der Zeitschrift für Gastroenterologie und Beauftragung der Koordinatoren durch die DGVS
April 2012	Kick-off-Treffen der Leitliniengruppe, Festlegung der methodischen Struktur und der inhaltlichen Gliederung der Leitlinie
Oktober 2012	Anmeldung bei der AWMF, Einladung der Fachgesellschaften
Oktober 2012–Januar 2014	erstellen der Empfehlungen
Januar 2014	Delphirunde
Juli/August 2014	Delphirunde
Oktober 2014	Delphirunde
4./5. September 2014	Konsensuskonferenz
27. November 2014	Konsensuskonferenz

1.4 Externe Begutachtung und Verabschiedung

Die Leitlinie wurde allen beteiligten Fachgesellschaften und der Patientenvertretung zur Stellungnahme vorgelegt und von diesen verabschiedet. Durch die AWMF erfolgte eine externe formale Beurteilung

1.5 Redaktionelle Unabhängigkeit und Umgang mit potenziellen Interessenskonflikten

Die Leitlinie wurde von der DGVS finanziert. Eine weitere Finanzierung durch Dritte erfolgte nicht, um Neutralität und Unabhängigkeit zu wahren.

Vor Beginn der Konsensuskonferenz legten alle Teilnehmer ihre potenziellen Interessenskonflikte offen (siehe Anhang) Hierfür wurden Interessenkonflikte schriftlich mithilfe eines Formblattes der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF), das materielle und immaterielle Interessen umfasst, erfasst und der Leitliniengruppe tabellarisch zur Verfügung gestellt. Potenzielle Interessenskonflikte wurden offen diskutiert und es wurde einstimmig beschlossen, dass Personen mit potenziellen Interessenskonflikten bei Abstimmungen über Empfehlungen, die von diesen Interessenskonflikten berührt werden könnten, sich ihrer Stimme enthalten. Es gab keine Enthaltungen.

1.6 Verbreitung und Implementierung

Die Leitlinie sowie der Methodenreport werden auf der Homepage der DGVS (www.dgvs.de) und der AWMF (www.dgvs.de) zum freien Download zur Verfügung gestellt. Die Langversion der Leitlinie wird in der „Zeitschrift für Gastroenterologie“ in deutscher Sprache publiziert. Zusätzlich soll eine Kompaktversion im „Deutschen Ärzteblatt“ in deutscher und englischer Sprache publiziert werden. Unterstützend wird eine Leitlinien-App zur Verfügung gestellt. Die Leitlinienempfehlungen werden darüber hinaus auf den Kongressen und themenbezogenen Fortbildungsveranstaltungen der DGVS vorgestellt.

1.7 Gültigkeitsdauer und Aktualisierungsverfahren

Die Gültigkeit der Leitlinie beträgt 5 Jahre (Juli 2020). Eine Überarbeitung der Leitlinie bei veränderter Datenlage erfolgt gegebenenfalls auch früher. Das Aktualisierungsverfahren wird koordiniert durch die DGVS-Geschäftsstelle.

Anhang: Interessenkonflikterklärungen – Tabellarische Zusammenfassung

1. Berater- bzw. Gutachtertätigkeit oder bezahlte Mitarbeit in einem wissenschaftlichen Beirat eines Unternehmens der Gesundheitswirtschaft (z. B. Arzneimittelindustrie, Medizinproduktindustrie), eines kommerziell orientierten Auftragsinstituts oder einer Versicherung.

2. Honorare für Vortrags- und Schulungstätigkeiten oder bezahlte Autoren- oder Co-Autorenschaften im Auftrag eines Unternehmens der Gesundheitswirtschaft, eines kommerziell orientierten Auftragsinstituts oder einer Versicherung.

3. Finanzielle Zuwendungen (Drittmittel) für Forschungsvorhaben oder direkte Finanzierung von Mitarbeitern der Einrichtung von Seiten eines Unternehmens der Gesundheitswirtschaft, eines kommerziell orientierten Auftragsinstituts oder einer Versicherung.

4. Eigentümerinteresse an Arzneimitteln/Medizinprodukten (z. B. Patent, Urheberrecht, Verkaufslizenz).

5. Besitz von Geschäftsanteilen, Aktien, Fonds mit Beteiligung von Unternehmen der Gesundheitswirtschaft.

6. Persönliche Beziehungen zu einem Vertretungsberechtigten eines Unternehmens der Gesundheitswirtschaft.

7. Mitglied von in Zusammenhang mit der Leitlinienentwicklung relevanten Fachgesellschaften/Berufsverbänden, Mandatsträger im Rahmen der Leitlinienentwicklung.

8. Politische, akademische (z. B. Zugehörigkeit zu bestimmten „Schulen“), wissenschaftliche oder persönliche Interessen, die mögliche Konflikte begründen könnten.

9. Gegenwärtiger Arbeitgeber, relevante frühere Arbeitgeber der letzten 3 Jahre.

Tab. 4

	Beilenhoff, Ulrike	Denzer, Ulrike	Eickhoff, Axel	Faiss, Siegbert
1	nein	nein	nein	Nein
2	nein	ja	ja	Ja
3	nein	ja	ja	Ja
4	nein	nein	nein	Nein
5	nein	nein	nein	Nein
6	nein	nein	nein	Nein
7	ja	ja	nein	Ja
8	nein	nein	nein	Nein
9	selbstständig, tätig als Fachdozentin und Praxisanleitung in den Endoskopiefachweiterbildungen für Pflegepersonal in Berlin, Heidelberg und München, organisiert vom Institut ekw-concept, stattlich anerkannte Weiterbildungsstätte, in Walldorf	seit 2010 Universitätsklinik Hamburg Eppendorf, Klinik für Endoskopie 2005 – 2010 Universitätsklinik Hamburg Eppendorf, Klinik für Gastroenterologie	Klinikum Hanau	Asklepios Klinik Barmbek
	Hüttl, Peter	In der Smitten, Susanne	Jakobs, Ralf	Jenssen, Christian
1	nein	nein	ja	Nein
2	ja	nein	ja	Ja
3	nein	nein	nein	Ja
4	nein	nein	nein	Nein
5	nein	nein	nein	Nein
6	nein	nein	nein	Nein
7	nein	nein	ja	Ja
8	nein	nein	nein	Nein
9	freiberuflicher Rechtsanwalt	Deutsches Zentrum für Hochschul- und Wissenschaftsforschung (DZHW) GmbH Goseriede 9 30 159 Hannover (ehemals HIS GmbH) seit 5,5 Jahren mein Arbeitgeber, daher keine weiteren Nennungen	Klinikum der Stadt Ludwigshafen gGmbH	Krankenhaus Märkisch Oderland GmbH, Starsusberg/Wriezen, Prötzeler Chaussee 5, 15 331 Strausberg
	Keuchel, Martin	Langer, Florian	Lynen Jansen, Petra	May, Andrea
1	ja	ja	nein	nein
2	ja	ja	nein	ja
3	ja	ja	nein	ja
4	nein	nein	nein	nein
5	nein	nein	nein	nein
6	nein	nein	nein	nein
7	ja	ja	nein	ja
8	nein	nein	nein	nein
9	Bethesda Krankenhaus Bergedorf, Hamburg	Universitätsklinikum Hamburg-Eppendorf	DGVS	HSK Wiesbaden, Sanaklinikum Offenbach
	Mennigen, Rudolf	Moog, Gero	Rosien, Ulrich	Rösch, Thomas
1	nein	nein	ja	ja
2	nein	nein	ja	ja
3	nein	nein	ja	ja
4	nein	nein	nein	nein
5	nein	nein	nein	nein
6	nein	nein	nein	nein
7	ja	nein	ja	ja
8	nein	nein	nein	nein
9	Universitätsklinikum Münster, Klinik für Allgemein- und Viszeralchirurgie	selbstständig	Israelitisches Krankenhaus in Hamburg, Orchideenstieg 14, 22 297 Hamburg	UKE Hamburg
	Vowinkel, Thorsten	Wehrmann, Till	Weickert, Uwe
1	nein	nein	ja
2	nein	ja	ja
3	nein	ja	nein
4	nein	nein	nein
5	nein	ja	nein
6	nein	nein	nein
7	nein	ja	nein
8	nein	nein	nein
9	Universitätsklinikum Münster	Stiftung Deutsche Klinik für Diagnostik GmbH, Wiesbaden	SLK-Kliniken Heilbronn

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• 1693 Gleeson FC, Clayton AC, Zhang L et al. Adequacy of endoscopic ultrasound core needle biopsy specimen of nonmalignant hepatic parenchymal disease. Clin Gastroenterol Hepatol 2008; 6: 1437-1440 Epub 2008 Jul 26
• 1694 Stavropoulos SN, Im GY, Jlayer Z et al. High yield of same-session EUS-guided liver biopsy by 19-gauge FNA needle in patients undergoing EUS to exclude biliary obstruction. Gastrointest Endosc 2012; 75: 310-318
• 1695 Gor N, Salem SB, Jakate S et al. Histological adequacy of EUS-guided liver biopsy when using a 19-gauge non-Tru-Cut FNA needle. Gastrointest Endosc 2014; 79: 170-172
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• 1697 Gimeno-García AZ, Paquin SC, Gariépy G et al. Comparison of endoscopic ultrasonography-guided fine-needle aspiration cytology results with and without the stylet in 3364 cases. Dig Endosc 2013; 25: 303-307 Epub 2012 Sep 19
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• 1721 Hocke M, Ignee A, Topalidis T et al. Back to the roots – should gastroenterologists perform their own cytology?. Z Gastroenterol 2013; 51: 191-195 Epub 2013 Feb 15
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• 1725 Harada R, Kato H, Fushimi S et al. An expanded training program for endosonographers improved self-diagnosed accuracy of endoscopic ultrasound-guided fine-needle aspiration cytology of the pancreas. Scand J Gastroenterol 2014; 49: 1119-1123
• 1726 Varadarajulu S, Holt BA, Bang JY et al. Training endosonographers in cytopathology: improving the results of EUS-guided FNA. Gastrointest Endosc 2015; 81: 104-110
• 1727 Kim B, Chhieng DC, Crowe DR et al. Dynamic telecytopathology of on site rapid cytology diagnoses for pancreatic carcinoma. Cytojournal 2006; 3: 27
• 1728 Khurana KK, Rong R, Wang D et al. J Dynamic telecytopathology for on-site preliminary diagnosis of endoscopic ultrasound-guided fine needle aspiration of pancreatic masses. Telemed Telecare 2012; 18: 253-259 Epub 2012 Feb 2
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• 1734 Turner BG, Cizginer S, Agarwal D et al. Diagnosis of pancreatic neoplasia with EUS and FNA: a report of accuracy. Gastrointest Endosc 2010; 71: 91-98
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• 1736 Schmidt RL, Kordy MA, Howard K et al. Risk-benefit analysis of sampling methods for fine-needle aspiration cytology: a mathematical modeling approach. Am J Clin Pathol 2013; 139: 336-344
• 1737 Schmidt RL, Walker BS, Howard K et al. Rapid on-site evaluation reduces needle passes in endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic lesions: a risk-benefit analysis. Dig Dis Sci 2013; 58: 3280-3286
• 1738 Wiersema MJ, Vilmann P, Giovannini M et al. Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology 1997; 112: 1087-1095
• 1739 Iglesias-Garcia J, Dominguez-Munoz JE, Abdulkader I et al. Influence of on-site cytopathology evaluation on the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of solid pancreatic masses. Am J Gastroenterol 2011; 106: 1705-1710 Epub 2011 Apr 12
• 1740 Schmidt RL, Witt BL, Matynia AP et al. Rapid on-site evaluation increases endoscopic ultrasound-guided fine-needle aspiration adequacy for pancreatic lesions. Dig Dis Sci 2013; 58: 872-882 Epub 2012 Oct 4
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• 1742 Hewitt MJ, McPhail MJ, Possamai L et al. EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc 2012; 75: 319-331
• 1743 Cherian PT, Mohan P, Douiri A et al. Role of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of solid pancreatic and peripancreatic lesions: is onsite cytopathology necessary?. HPB (Oxford) 2010; 12: 389-395
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• 1745 Weynand B, Borbath I, Galant C et al. Optimizing specimen collection and laboratory procedures reduces the non-diagnostic rate for endoscopic ultrasound-guided fine-needle aspiration of solid lesions of the pancreas. Cytopathology 2013; 24: 177-184 Epub 2011 Sep 14
• 1746 LeBlanc JK, Ciaccia D, Al-Assi MT et al. Optimal number of EUS-guided fine needle passes needed to obtain a correct diagnosis. Gastrointest Endosc 2004; 59: 475-481
• 1747 Bang JY, Magee SH, Ramesh J et al. Randomized trial comparing fanning with standard technique for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic mass lesions. Endoscopy 2013; 45: 445-450
• 1748 Siddiqui AA, Brown LJ, Hong SK et al. Relationship of pancreatic mass size and diagnostic yield of endoscopic ultrasound-guided fine needle aspiration. Dig Dis Sci 2011; 56: 3370-3375 Epub 2011 Jun 19
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• 1750 Varadarajulu S, Tamhane A, Eloubeidi MA. Yield of EUS-guided FNA of pancreatic masses in the presence or the absence of chronic pancreatitis. Gastrointest Endosc 2005; 62: 728-736 ; quiz 751, 753
• 1751 Fritscher-Ravens A, Brand L, Knöfel WT et al. Comparison of endoscopic ultrasound-guided fine needle aspiration for focal pancreatic lesions in patients with normal parenchyma and chronic pancreatitis. Am J Gastroenterol 2002; 97: 2768-2775
• 1752 Krishna NB, Mehra M, Reddy AV et al. EUS/EUS-FNA for suspected pancreatic cancer: influence of chronic pancreatitis and clinical presentation with or without obstructive jaundice on performance characteristics. Gastrointest Endosc 2009; 70: 70-79 Epub 2009 Feb 27
• 1753 Saftoiu A, Vilmann P, Guldhammer Skov B et al. Endoscopic ultrasound (EUS)-guided Trucut biopsy adds significant information to EUS-guided fine-needle aspiration in selected patients: a prospective study. Scand J Gastroenterol 2007; 42: 117-125
• 1754 Eloubeidi MA, Tamhane AR, Buxbaum JL. Unusual, metastatic, or neuroendocrine tumor of the pancreas: a diagnosis with endoscopic ultrasound-guided fine-needle aspiration and immunohistochemistry. Saudi J Gastroenterol 2012; 18: 99-105
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• 1756 Stelow EB, Murad FM, Debol SM et al. A limited immunocytochemical panel for the distinction of subepithelial gastrointestinal mesenchymal neoplasms sampled by endoscopic ultrasound-guided fine-needle aspiration. Am J Clin Pathol 2008; 129: 219-225
• 1757 Eloubeidi MA, Khan AS, Luz LP et al. Combined use of EUS-guided FNA and immunocytochemical stains discloses metastatic and unusual diseases in the evaluation of mediastinal lymphadenopathy of unknown etiology. Ann Thorac Med 2012; 7: 84-91
• 1758 Noda Y, Fujita N, Kobayashi G et al. Diagnostic efficacy of the cell block method in comparison with smear cytology of tissue samples obtained by endoscopic ultrasound-guided fine-needle aspiration. J Gastroenterol 2010; 45: 868-875
• 1759 Loya A, Nadeem M, Yusuf MA. Use of ancillary techniques in improving the yield of samples obtained at endoscopic ultrasound-guided fine needle aspiration of thoracic and abdominal lymph nodes. Acta Cytol 2014; 58: 192-197
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• 1761 Mertz H, Gautam S. The learning curve for EUS-guided FNA of pancreatic cancer. Gastrointest Endosc 2004; 59: 33-37
• 1762 Eloubeidi MA, Tamhane A. EUS-guided FNA of solid pancreatic masses: a learning curve with 300 consecutive procedures. Gastrointest Endosc 2005; 61: 700-708
• 1763 Skov BG, Baandrup U, Jakobsen GK et al. Cytopathologic diagnoses of fine-needle aspirations from endoscopic ultrasound of the mediastinum: reproducibility of the diagnoses and representativeness of aspirates from lymph nodes. Cancer 2007; 111: 234-241
• 1764 Eltoum IA, Chhieng DC, Jhala D et al. Cumulative sum procedure in evaluation of EUS-guided FNA cytology: the learning curve and diagnostic performance beyond sensitivity and specificity. Cytopathology 2007; 18: 143-150 Epub 2007 Mar 27
• 1765 Irisawa A, Mishra G, Hernandez LV et al. Quantitative analysis of endosonographic parenchymal echogenicity in patients with chronic pancreatitis. J Gastroenterol Hepatol 2004; 19: 1199-1205
• 1766 Das A, Nguyen CC, Li F et al. Digital image analysis of EUS images accurately differentiates pancreatic cancer from chronic pancreatitis and normal tissue. Gastrointest Endosc 2008; 67: 861-867 Epub 2008 Jan 7
• 1767 Zhang MM, Yang H, Jin ZD et al. Differential diagnosis of pancreatic cancer from normal tissue with digital imaging processing and pattern recognition based on a support vector machine of EUS images. Gastrointest Endosc 2010; 72: 978-985 Epub 2010 Sep 19
• 1768 Kumon RE, Pollack MJ, Faulx AL et al. In vivo characterization of pancreatic and lymph node tissue by using EUS spectrum analysis: a validation study. Gastrointest Endosc 2010; 71: 53-63 Epub 2009 Nov 17
• 1769 Dietrich CF, Săftoiu A, Jenssen C. Real time elastography endoscopic ultrasound (RTE-EUS), a comprehensive review. Eur J Radiol 2014; 83: 405-414 Epub 2013 May 1
• 1770 Săftoiu A, Dietrich CF, Vilmann P. Contrast-enhanced harmonic endoscopic ultrasound. Endoscopy 2012; 44: 612-617 Epub 2012 Apr 23
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• 1772 Cosgrove D, Piscaglia F, Bamber J et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall in Med 2013; 34: 238-253
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• 1774 Săftoiu A, Vilmann P, Gorunescu F et al. Accuracy of endoscopic ultrasound elastography used for differential diagnosis of focal pancreatic masses: a multicenter study. Endoscopy 2011; 43: 596-603 Epub 2011 Mar 24
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• 1782 Ying L, Lin X, Xie ZL et al. Clinical utility of endoscopic ultrasound elastography for identification of malignant pancreatic masses: a meta-analysis. J Gastroenterol Hepatol 2013; 28: 1434-1443
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• 1784 Xu W, Shi J, Zeng X et al. EUS elastography for the differentiation of benign and malignant lymph nodes: a meta-analysis. Gastrointest Endosc 2011; 74: 1001-1009 quiz 1115.e1–e4
• 1785 Paterson S, Duthie F, Stanley AJ. Endoscopic ultrasound-guided elastography in the nodal staging of oesophageal cancer. World J Gastroenterol 2012; 18: 889-895
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• 1787 Larsen MH, Fristrup C, Hansen TP et al. Endoscopic ultrasound, endoscopic sonoelastography, and strain ratio evaluation of lymph nodes with histology as gold standard. Endoscopy 2012; 44: 759-766 Epub 2012 Jul 2
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• 1789 Larsen MH, Fristrup CW, Mortensen MB. Intra- and interobserver agreement of endoscopic sonoelastography in the evaluation of lymph nodes. Ultraschall in Med 2011; 32 (Suppl. 02) E45-50 Epub 2011 Dec 22
• 1790 Becker D, Strobel D, Bernatik T et al. Echo-enhanced color- and power-Doppler EUS for the discrimination between focal pancreatitis and pancreatic carcinoma. Gastrointest Endosc 2001; 53: 784-789
• 1791 Dietrich CF, Ignee A, Frey H. Contrast-enhanced endoscopic ultrasound with low mechanical index: a new technique. Z Gastroenterol 2005; 43: 1219-1223
• 1792 Kitano M, Sakamoto H, Matsui U et al. A novel perfusion imaging technique of the pancreas: contrast-enhanced harmonic EUS (with video). Gastrointest Endosc 2008; 67: 141-150
• 1793 Hocke M, Ignee A, Dietrich CF. Advanced endosonographic diagnostic tools for discrimination of focal chronic pancreatitis and pancreatic carcinoma--elastography, contrast enhanced high mechanical index (CEHMI) and low mechanical index (CELMI) endosonography in direct comparison. Z Gastroenterol 2012; 50: 199-203, doi: 10.1055/s-0031-1281824. Epub 2012 Feb 1
• 1794 Sanchez MV, Varadarajulu S, Napoleon B. EUS contrast agents: what is available, how do they work, and are they effective?. Gastrointest Endosc 2009; 69: S71-77
• 1795 Agarwal B, Krishna NB, Labundy JL et al. EUS and/or EUS-guided FNA in patients with CT and/or magnetic resonance imaging findings of enlarged pancreatic head or dilated pancreatic duct with or without a dilated common bile duct. Gastrointest Endosc 2008; 68: 237-342 ; quiz 334, 335, Epub 2008 Apr 18
• 1796 Klapman JB, Chang KJ, Lee JG et al. Negative predictive value of endoscopic ultrasound in a large series of patients with a clinical suspicion of pancreatic cancer. Am J Gastroenterol 2005; 100: 2658-2661
• 1797 Tamm EP, Loyer EM, Faria SC et al. Retrospective analysis of dual-phase MDCT and follow-up EUS/EUS-FNA in the diagnosis of pancreatic cancer. Abdom Imaging 2007; 32: 660-667
• 1798 Dewitt J, Devereaux BM, Lehman GA et al. Comparison of endoscopic ultrasound and computed tomography for the preoperative evaluation of pancreatic cancer: a systematic review. Clin Gastroenterol Hepatol 2006; 4: 717-725 ;quiz 664, Epub 2006 May 3
• 1799 D’Onofrio M, Crosara S, Signorini M et al. Comparison between CT and CEUS in the diagnosis of pancreatic adenocarcinoma. Ultraschall in Med 2013; 34: 377-381 Epub 2012 Sep 21
• 1800 D’Onofrio M, De Robertis R, Capelli P et al. Uncommon presentations of common pancreatic neoplasms: a pictorial essay. Abdom Imaging 2015; 40: 1629-1644
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• 1802 Hocke M, Ignee A, Topalidis T et al. Contrast-enhanced endosonographic Doppler spectrum analysis is helpful in discrimination between focal chronic pancreatitis and pancreatic cancer. Pancreas 2007; 35: 286-288
• 1803 Hocke M, Schmidt C, Zimmer B et al. (Contrast enhanced endosonography for improving differential diagnosis between chronic pancreatitis and pancreatic cancer). Dtsch Med Wochenschr 2008; 133: 1888-1892 Epub 2008 Sep 1
• 1804 Săftoiu A, Iordache SA, Gheonea DI et al. Combined contrast-enhanced power Doppler and real-time sonoelastography performed during EUS, used in the differential diagnosis of focal pancreatic masses (with videos). Gastrointest Endosc 2010; 72: 739-747 Epub 2010 Aug 2
• 1805 Fusaroli P, Spada A, Mancino MG et al. Contrast harmonic echo-endoscopic ultrasound improves accuracy in diagnosis of solid pancreatic masses. Clin Gastroenterol Hepatol 2010; 8: 629-634.e1-e2 Epub 2010 Apr 24
• 1806 Kitano M, Kudo M, Yamao K et al. Characterization of small solid tumors in the pancreas: the value of contrast-enhanced harmonic endoscopic ultrasonography. Am J Gastroenterol 2012; 107: 303-310 Epub 2011 Oct 18
• 1807 Matsubara H, Itoh A, Kawashima H et al. Dynamic quantitative evaluation of contrast-enhanced endoscopic ultrasonography in the diagnosis of pancreatic diseases. Pancreas 2011; 40: 1073-1079
• 1808 Napoleon B, Alvarez-Sanchez MV, Gincoul R et al. Contrast-enhanced harmonic endoscopic ultrasound in solid lesions of the pancreas: results of a pilot study. Endoscopy 2010; 42: 564-570 Epub 2010 Jun 30
• 1809 Gheonea DI, Streba CT, Ciurea T et al. Quantitative low mechanical index contrast-enhanced endoscopic ultrasound for the differential diagnosis of chronic pseudotumoral pancreatitis and pancreatic cancer. BMC Gastroenterol 2013; 13: 2
• 1810 Imazu H, Kanazawa K, Mori N et al. Novel quantitative perfusion analysis with contrast-enhanced harmonic EUS for differentiation of autoimmune pancreatitis from pancreatic carcinoma. Scand J Gastroenterol 2012; 47: 853-860 Epub 2012 Apr 17
• 1811 Seicean A, Badea R, Stan-Iuga R et al. The added value of real-time harmonics contrast-enhanced endoscopic ultrasonography for the characterisation of pancreatic diseases in routine practice. J Gastrointestin Liver Dis 2010; 19: 99-104
• 1812 Seicean A, Badea R, Stan-Iuga R et al. Quantitative contrast-enhanced harmonic endoscopic ultrasonography for the discrimination of solid pancreatic masses. Ultraschall in Med 2010; 31: 571-576 Epub 2010 Nov 15
• 1813 Park JS, Kim HK, Bang BW et al. Effectiveness of contrast-enhanced harmonic endoscopic ultrasound for the evaluation of solid pancreatic masses. World J Gastroenterol 2014; 20: 518-524
• 1814 Gincul R, Palazzo M, Pujol B et al. Contrast-harmonic endoscopic ultrasound for the diagnosis of pancreatic adenocarcinoma: a prospective multicenter trial. Endoscopy 2014; 46: 373-379
• 1815 Fusaroli P, D’Ercole MC, De Giorgio R et al. Contrast harmonic endoscopic ultrasonography in the characterization of pancreatic metastases (with video). Pancreas 2014; 43: 584-587
• 1816 Gong TT, Hu DM, Zhu Q. Contrast-enhanced EUS for differential diagnosis of pancreatic mass lesions: a meta-analysis. Gastrointest Endosc 2012; 76: 301-309 Epub 2012 Jun 15
• 1817 Fusaroli P, Kypraios D, Mancino MG et al. Interobserver agreement in contrast harmonic endoscopic ultrasound. J Gastroenterol Hepatol 2012; 27: 1063-1069
• 1818 Kitano M, Kamata K, Imai H et al. Contrast-Enhanced Harmonic EUS for Pancreatobiliaty Diseases. Dig Endosc 2015; Epub ahead of print
• 1819 Ueda K, Yamashita Y, Itonaga M. Real-time contrast-enhanced endoscopic ultrasonography-guided fine-needle aspiration (with video). Dig Endosc 2013; 25: 631 Epub 2013 Sep 30. No abstract available
• 1820 Fusaroli P, Eloubeidi MA. Diagnosis of pancreatic cancer by contrast-harmonic endoscopic ultrasound (EUS): complementary and not competitive with EUS-guided fine-needle aspiration. Endoscopy 2014; 46: 380-381 Epub 2014 Apr 16. No abstract available
• 1821 Kim KW, Park SH, Pyo J et al. Imaging features to distinguish malignant and benign branch-duct type intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis. Ann Surg 2014; 259: 72-81
• 1822 Anand N, Sampath K, Wu BU. Cyst features and risk of malignancy in intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis. Clin Gastroenterol Hepatol 2013; 11: 913-921 ; quiz e959-960
• 1823 Tanaka M, Fernández-del Castillo C, Adsay V et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012; 12: 183-197 Epub 2012 Apr 16
• 1824 Del Chiaro M, Verbeke C, Salvia R et al. European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis 2013; 45: 703-711
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