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The therapeutic usage of EUS is being developed. EUS-guided biliary drainage (EUSBD) is a recognized viable replacement for percutaneous transhepatic biliary drainage (PTBD) in severe cases with the obstructive biliary disease having ERCP failure due to a failure in cannulation or those with surgically altered anatomies, such as hepatico-jejunal anastomosis following Billroth II reconstruction, Roux-en-Y limb, Whipple procedure, or Roux-en-Y gastric bypass, or cases with inaccessible papilla because of severe duodenal inflammatory structure.

Background Despite the increasing incidence of colorectal cancer (CRC) in the Egyptian population, it still seems that there is a significant lack of awareness regarding the disease. This study aimed to assess the Egyptian population's awareness of CRC regarding its risk factors, the screening procedures, and the appropriate responses to its diagnosis. Method A cross-sectional study was conducted in Egypt between July 2022 and March 2023 and recruited a convenient sample of adults from seven governorates representing different geographic areas, and socioeconomic and educational backgrounds with the help of the validated Bowel Cancer Awareness Measure (CAM) version 2.1. The modified Arabic questionnaire was validated through a pilot study including 30 patients. Then it was presented through a Google form before being shared via online methods and face-to-face interviews. The questionnaire provided both numerical and categorical data, which were analyzed accordingly. The Chi-square, the Fisher exact, and the Man-Whitney test were used to compare colorectal cancer poor and good knowledge groups. Logistic regression analysis was conducted to predict the factors that affected the awareness level of the study population. Results Nine hundred forty individuals participated in the survey. Their ages ranged from 18 to 86 years old, with an average of 37.38 ± 12.22 years. The mean Knowledge score was 14.29 ± 7.05 out of 37 with most of our participants (71%) having poor knowledge about CRC. Most of the participants (64.1%) chose colonoscopy as the best screening modality, followed by an abdominal CT (27.8%), and fecal occult blood (15.5%). The study revealed significant differences between participants with good and poor knowledge of colorectal cancer. (78.5%) of participants with good CRC knowledge lived in cities, (85.4%) attained university or higher educational level, and (87.2%) of them were nonsmokers ( p  < 0.05%). Conclusion In general, there was a lack of awareness about Colorectal cancer among the Egyptian population especially among rural and lower educational levels, and more health education campaigns are required to enhance CRC prevention efforts in Egypt.

Background Colonic Dieulafoy’s lesions (DLs) are an extremely rare cause of acute gastrointestinal bleeding. However, it could be presented from self-limiting, mild bleeding episodes up to recurrent, massive life-threatening hemorrhage. Case presentation We present a case of 9-year-old female with recurrent attacks of hematochezia. The colonoscopy showed actively bleeding Dieulafoy’s lesions at the rectosigmoid colon that was successfully managed endoscopically by the application of two hemoclips. Conclusion A prompt and accurate diagnosis in patients with a Dieulafoy’s lesion carries paramount importance. A meticulous examination and proper resuscitation are a must because massive, uncontrolled bleeding from this lesion may culminate in the death of the patient fairly quickly.

Background Choledocholithiasis occurs in up to 20% of patients with gallstones. Diagnosing choledocholithiasis can be challenging. Previously, the gold standard for diagnosis was endoscopic retrograde cholangiopancreatography (ERCP). However, small stones often evade detection through ERCP and magnetic resonance cholangiopancreatography (MRCP). Endoscopic ultrasound (EUS) has proven effective in identifying common bile duct (CBD) stones that MRCP and ERCP might miss, particularly small stones or those lodged in the distal CBD or papillary region. The study aimed to evaluate the accuracy of EUS in detecting CBD stones missed by MRCP and ERCP. Methods A case–control study was conducted; we enrolled 30 patients who were presented with calculous obstructive jaundice and had undergone both ERCP and MRCP. A stent was inserted in these patients. Prior to stent removal, these patients underwent EUS to evaluate its effectiveness in detecting any remaining CBD stones post-ERCP. The sensitivity and specificity of EUS, ERCP, and MRCP were compared based on the presence, size, and number of detected stones. Results The mean age of involved patients was 50.3 ± 10.2 years. ERCP demonstrated a sensitivity of 44.4%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 16.6%, and an accuracy of 50%. MRCP showed a sensitivity of 81.5%, specificity of 100%, PPV of 100%, NPV of 37.5%, and an accuracy of 83.3% when compared with EUS results. The complication rate for EUS was significantly lower than that for diagnostic ERCP. Additionally, an EUS-based strategy was more cost-effective than diagnostic ERCP for patients with low, moderate, or high risk. Conclusion Endoscopic ultrasound (EUS) is a promising, non-invasive, non-contrast technique that may serve as a superior diagnostic tool compared with MRCP and ERCP, particularly for detecting small stones or those impacted in the distal CBD or papillary region.

Background Incidentally discovered focal liver lesions (FLLs) are a common reason for referral to hepatobiliary services. These lesions are frequently found in patients with colorectal cancer, cirrhosis, or incidentally during evaluations for abdominal pain or shock. Several established diagnostic tools such as magnetic resonance imaging (MRI), transabdominal ultrasound (US), and computed tomography (CT) are well-studied for assessing liver diseases. Endoscopic ultrasound (EUS), traditionally used for evaluating the mediastinum, biliary tract, esophagus, stomach, and pancreas, is increasingly complementing these traditional diagnostic methods in hepatology. The study aimed to delineate the endoscopic ultrasound elastography role in visualization and hepatic focal hepatic tissue differentiation of lesions in comparison to the routine radiological and laboratory methods. Methods A cross-sectional study was conducted, we enrolled 41 patients with hepatic focal lesions, abdominal ultrasonography, triphasic CT abdomen, and Endosonography examinations were performed on all participants. Results There was a highly significant difference between the studied groups as regards the Strain Ratio and Echogenicity (P0.01). Conclusion Ultrasound elastography and strain ratio are promising, non-invasive, nondependent on any contrast material techniques that could significantly enhance routine grey-scale sonographic examinations of the liver by better delineating the characteristics of hepatic focal lesions.

Background Esophagitis dissecans superficialis (EDS) is a rare desquamative esophageal condition with a wide range of presentations, from asymptomatic cases to those with severe, life-threatening symptoms. EDS has a strong association with several conditions, such as autoimmune diseases, smoking, and certain medications, although it can also occur without any apparent cause (idiopathic). Diagnosis involves a comprehensive approach, including clinical assessment (history and examination), endoscopic examination, histopathological analysis, and the exclusion of other potential causes. There is still no established standard treatment for EDS, as many cases resolve spontaneously without long-term complications. Case presentation. We present a case of a 73-year-old female with an episode of upper gastrointestinal bleeding (UGIB) due to Esophagitis dissecans superficialis, which had a favorable outcome after therapy with a proton pump inhibitor (PPI). Conclusion Although EDS is a rare condition, it should be considered a cause of UGIB in patients with risk factors.

Background During COVID-19 pandemic, a lot of newly discovered symptoms and presentations are emerging. Neurological symptoms of corona virus disease 19 (COVID19) have been reported including central nervous symptoms (CNS), peripheral nervous symptoms (PNS), and skeletal muscular symptoms; however, data are scarce about the exact occurrence of neurological affection during COVID-19 infection. Case presentation We present a case of a 67-year-old male patient with proven COVID-19 infection who developed acute confusion state, behavioral changes, agitation, and one attack of loss of consciousness 8 days following the infection. Laboratory profile, computed tomography (CT) brain, magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) analysis all were normal, and the patients were highly suspicion of autoimmune encephalitis due to COVID-19 infection. The patient received pulse steroid therapy with complete regaining the conscious level. Conclusion This clinical case emphasizes the possible relationship between COVID-19 infection and autoimmune encephalitis.

Tuberculous lymphadenopathy presents a challenging diagnostic scenario, particularly in regions with high tuberculosis (TB) prevalence. Abdominal TB accounts for 10% of extrapulmonary TB cases. Diagnosing abdominal TB is difficult due to nonspecific clinical, radiological, and endoscopic findings. Blood and skin tests for TB exhibit variable sensitivities and specificities; therefore, histopathological diagnosis and molecular testing of tissue samples may provide greater accuracy than blood-based tests. Obtaining tissue samples under ultrasonographic or CT guidance can be difficult and risky, especially in intra-abdominal and mediastinal regions. Endoscopic ultrasound (EUS) and EUS-guided fine-needle biopsy (EUS-FNB) offer a safe technique for obtaining tissue samples for the diagnosis of abdominal and mediastinal TB. Comparative analyses of the Gene X-pert MTB/RIF assay and PCR techniques demonstrate nuanced diagnostic capabilities. Gene X-pert enables rapid molecular detection with high specificity for rifampicin resistance, whereas PCR facilitates molecular amplification of bacterial DNA. EUS provides the critical advantage of real-time imaging and precise tissue sampling. Several studies have found that EUS-FNB yields significantly higher diagnostic accuracy in complex TB presentations, with detection rates ranging from 78 to 92% across various anatomical sites. This review explores the diagnostic efficacy of molecular techniques, specifically polymerase chain reaction (PCR) and the Gene X-pert MTB/RIF assay, in detecting Mycobacterium tuberculosis in tissue samples obtained through EUS-FNB. Additionally, we evaluated the sensitivity, specificity, and rapid detection capabilities of these molecular methods compared to traditional diagnostic techniques. We further discussed whether molecular techniques such as PCR and Gene X-pert provide a powerful diagnostic strategy for TB lymphadenopathy in EUS-FNB tissue samples, thereby overcoming the limitations of conventional diagnostic methods.

Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) and endoscopic ultrasound-guided ethanol ablation (EUS-EA) are emerging novel methods for managing non-functioning and functioning pNET and adenocarcinoma in the pancreas. To assess the safety profile, feasibility, and outcomes of EUS-RFA and EUS-EA of focal pancreatic masses. This prospective study included 27 patients, 15 males and 12 females, with a mean age of 36.38 years. EUS-RFA was carried out in 13 patients; 11 had pancreatic insulinoma, and 2 had advanced pancreatic adenocarcinoma. The mean size of the masses was 20.6 mm, while that of the insulinomas was 17.4 mm. The median number of needle passes was 3, with a range of 1 to 6. RFA was conducted using 19G EUSRA needles from Taewoong Co., Ltd., South Korea. No minor or major complications were observed. EUS-EA was carried out in 14 patients, all of whom had pancreatic insulinoma. The mean size of the masses was 15.3 mm. The median number of needle passes was 2, with a range of 1 to 3. We used 19G and 22G echo tip FNA needles from Cook Company, USA. The mean duration of follow-up was 12.4 months. There was mild to moderate acute pancreatitis in 4 patients in the EUS-EA group; all were relieved by conservative therapy, and no hospital admission was required. No early or late significant complications were reported in the EUS-RFA group. There was a complete clinical cure of 10 out of 11 (91%) patients with pancreatic insulinoma who underwent EUS-RFA. However, 1 patient required three sessions, and 2 patients required two sessions of EUS-RFA. The 11 patient with insulinoma showed a poor response after the first session, then a partial response after the second session of EUS-RFA. The size of the two masses with advanced adenocarcinoma was decreased, but no downstaging of the masses was achieved. There was a complete clinical cure of 8 out of 14 (57%) patients with pancreatic insulinoma who underwent EUS-EA. No clinical cure was observed in 4 patients; 3 underwent major surgery, and the 4 one underwent EUS-RFA. The last 2 patients showed a partial clinical response with decreased frequency, duration, and severity of hypoglycemic attacks. They were managed by diet regulation; no major surgery was needed. EUS-RFA and EUS-EA can potentially treat lesions and control symptoms. EUS-RFA is a more promising and safer technique for managing functioning insulinomas. However, it cannot downstage pancreatic ductal adenocarcinoma patients. EUS-EA seems less efficient, with more adverse events than EUS-RFA.

Fishbones are frequently swallowed by foreign objects that can penetrate the gastrointestinal tract. Nonetheless, it is quite uncommon for these fishbones to become lodged within the tract, resulting in the formation of foreign body granulomas that resemble submucosal tumors. When encountering this situation, it's important to consider differential diagnoses such as gastric intestinal stromal tumor, gastric leiomyoma, and gastric neurofibroma. We present a case of gastric foreign body granuloma that presents with dull aching epigastric pain. The patient gave a vague history of displaced intrauterine contraceptive devices (IUCD). Contrast CT and PET scan showed a gastric antral mass possibly a gastric cancer or a migrating IUCD. Endoscopic ultrasound (EUS) suggested a perigastric foreign body reaction due to the presence of a linear echogenic structure in between the markedly thickened gastric antral wall and the right lobe of the liver. EUS-guided fine needle biopsy (EUS-FNB) revealed non-specific inflammatory reaction. Afterward, surgical exploration unveiled the cause of the mass as a foreign body granuloma caused by a perforating fishbone.