Publications by authors named "Christian Jenssen"

78 Publications

Quality of reporting in endoscopic ultrasound: Results of an international multicenter survey (the QUOREUS study).

Endosc Int Open 2021 Jul 21;9(7):E1171-E1177. Epub 2021 Jun 21.

Gastroenterology Unit, Hospital of Imola, Department of Medical and Surgical Sciences - DIMEC, University of Bologna, Italy.

The endoscopic report has a key role in quality improvement for gastrointestinal endoscopy. High quality standards have been set by the endoscopic societies in this field. Unlike other digestive endoscopy procedures, the quality of reporting in endoscopic ultrasound (EUS) has not been thoroughly evaluated and a reference standard is lacking. We performed an international online survey concerning the attitudes of endosonographers towards EUS reports in order to understand the needs for standardization and quality improvement. Endosonographers from different countries and institutional setting, with varying case volume and experience were invited to take part to complete a structured questionnaire. We collected replies from 171 endosonographers. Overall analysis of results according to case volume, experience and working environment of respondents (academic, public hospital, private) are provided. In brief, everyone agreed on the need for standardization of EUS reporting. The use of minimal standard terminology and a structured tree with mandatory items was considered of primary importance. Image documentation was also deemed fundamental in complementing EUS reports both for patient documentation and research purposes. A strong demand for connection and consultation among endosonographers for clinical and training needs was also found. In this respect, a formal expert consultation network was advocated in order to improve the quality of reporting in EUS. Our survey showed a strong agreement among endosonographers who expressed the need for a standardization in order to improve the report and, as a consequence, the quality of EUS.
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http://dx.doi.org/10.1055/a-1482-7769DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8216784PMC
July 2021

A structured Endoscopic Ultrasound training program in Germany improves knowledge and competence.

Med Ultrason 2021 Jun 10. Epub 2021 Jun 10.

Institut for Medical Education, University Hospital of LMU Munich, Munich, Germany.

Aims: Limited evidence on how to organize pre-patient training in Endoscopic Ultrasound (EUS) and how to evaluate its effect on knowledge and skills are available. The aim of our study was to assess the impact of a structured multi-site training program on EUS competence in Germany.

Material And Methods: In a prospective study design, evaluation of 64 trainees was conducted during four three-day training courses with equal curricula at three sites. Participants completed a structured pre- and post-test questionnaire consisting of 4 items to evaluate the relevance and acceptance of the training components (theoretical teaching, video sessions, live demonstration, hands-on experience) on a 5-point Likert scale, as well as a Likert scale to judge the self-rated improvement in EUS competence. To assess knowledge, 12 multiple choice (MC) questions had to be answered by all participants in a pre- and a post-test design. Also differences between beginners and advanced learners were analysed.

Results: Overall evaluation on acceptance received above-average results with a median of 4 or 5 (IQR 1-2) on Likert scale (1=completely disagree, 5=completely agree). In the post-test self-rated EUS skills improved from 4 to 2 on the Likert scale (IQR=1, p=0.001, 1=excellent EUS skills, 5=no EUS skills). Results of the MC-test of all trainees showed significant improvement in theoretical knowledge from 7.9±1.9 to 8.8±1.9 points (mean±SD, p=0.001).

Conclusions: Our study provides arguments for the usefulness of a structured EUS training program resulting in a positive acceptance and high self-rated EUS competence by the participants and significant improvements in knowledge.
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http://dx.doi.org/10.11152/mu-2892DOI Listing
June 2021

Interventional endoscopic ultrasound.

Curr Opin Gastroenterol 2021 Jun 4. Epub 2021 Jun 4.

Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Switzerland Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK Department of Internal Medicine, Krankenhaus Maerkisch-Oderland, D-15344 Strausberg and Brandenburg Institute of Clinical Ultrasound at Medical University Brandenburg, Germany.

Purpose Of Review: To update on recent advances in interventional endoscopic ultrasound (INVEUS) techniques.

Recent Findings: The introduction of linear echoendoscopes with larger instrument channels and the combined development of new tools and devices have enabled various new applications of minimally invasive endoscopic ultrasound (EUS)-guided transluminal interventions of the pancreas, biliary system and peri-gastrointestinal structures. In this review, EUS-guided interventions are discussed and evaluated: drainage of peripancreatic fluid collections, access and drainage of bile ducts, gallbladder and pancreatic duct, treatment of gastrointestinal haemorrhage, coeliac plexus block and coeliac plexus neurolysis, fiducial placement, solid and cystic tumour ablation, drug delivery and brachytherapy, gastroenterostomy, angiotherapy and other EUS-guided applications. The EUS-guided interventions are classified based on the available evidence as established or experimental, standardized or nonstandardized procedures in common or rare diseases with well or little known complications and their established or nonestablished treatment.

Summary: Some EUS-guided interventions have sparse published evidence with only single-centre studies, case series or individual case reports, others like drainage of peripancreatic fluid collections have become widely accepted practice. INVEUS has been accepted as an alternative to several surgical approaches, EUS-guided techniques result in faster recovery times, shorter hospital stay and lower costs.
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http://dx.doi.org/10.1097/MOG.0000000000000760DOI Listing
June 2021

WFUMB Position Paper-Incidental Findings, How to Manage: Spleen.

Ultrasound Med Biol 2021 Aug 26;47(8):2017-2032. Epub 2021 May 26.

Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland. Electronic address:

The World Federation for Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings (IFs) with a series of publications entitled "Incidental Imaging Findings-The Role of Medical Ultrasound." IFs are less commonly encountered in the spleen than in many other abdominal organs but remain a frequent dilemma in clinical practice. A histological diagnosis is rarely necessary for patient management. Many IFs, such as secondary spleens and splenic cysts, are harmless and do not require any further investigation. The diagnosis of many other focal splenic lesions is, however, often problematic. The following overview is intended to illustrate a variety of incidentally detected spleen pathologies such as size variants, shape variants, secondary spleens, focal splenic lesions and splenic calcifications. It should aid the examiner in establishing the diagnosis. Moreover, it should help the ultrasound practitioner decide which pathologies need no further investigation, those requiring interval imaging and cases in which immediate further diagnostic procedures are required.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2021.03.032DOI Listing
August 2021

"Knobology" in Doppler Ultrasound.

Med Ultrason 2021 May 4. Epub 2021 May 4.

Department Allgemeine Innere Medizin (DAIM) Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland.

Ultrasonography is a ubiquitous and indispensable diagnostic and therapeutic tool in medicine. Due to modern equipment and automatic image optimization, nowadays the introduction of ultrasound imaging requires only little technical and physical knowledge. However, profound knowledge of the device function repertoire and underlying mechanisms are essential foroptimal image adjustment and documentation. From a medical as well as an aesthetic point of view, the goal should always be to achieve the best possible image quality. This article provides an overview of handling of ultrasound systems, fundamental adjustments and their optimization in Doppler ultrasound.
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http://dx.doi.org/10.11152/mu-3216DOI Listing
May 2021

[Spleen biopsy: "pros and cons" or better "when and when not?"]

Z Gastroenterol 2021 Mar 22. Epub 2021 Mar 22.

Klinik für Hämatologie, Onkologie und Immunologie, UKGM Marburg und Philipps-Universität Marburg.

Due to the relatively high complication rate, the necessity of a spleen biopsy is controversially discussed. In establishing its indication, the clinical background and performed diagnostics must be considered. Based on the medical history, imaging procedures and sonographic course, different clinical scenarios are conceivable. The aim of this review is to describe the indications of splenic biopsy considering various clinical scenarios.
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http://dx.doi.org/10.1055/a-1404-3926DOI Listing
March 2021

Diagnosis and staging of lung cancer with the use of one single echoendoscope in both the trachea and the esophagus: A practical guide.

Endosc Ultrasound 2021 Mar 2. Epub 2021 Mar 2.

Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland.

Accurate staging of non-small cell lung cancer (NSCLC) is crucial for allocation to surgical, medical or multimodal treatment. EUS and endobronchial ultrasound (EBUS) have gained ground in the diagnosis and staging of lung cancer in addition to radiological imaging (e.g., computed tomography, fluoroscopy, and magnetic resonance imaging), nuclear medicine techniques (e.g. positron emission tomography, PET), combined techniques (e.g., fluorodesoxyglucosepositron emission tomography scanning), and sonographic imaging including conventional transcutaneous mediastinal and lung ultrasound. By using one single echoendoscope in both the trachea and the esophagus, surgical staging procedures (e.g. mediastinoscopy and video assisted thoracoscopy) can be avoided in a considerable proportion of patients with NSCLC.
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http://dx.doi.org/10.4103/EUS-D-20-00139DOI Listing
March 2021

General principles of image optimization in EUS.

Endosc Ultrasound 2021 May-Jun;10(3):168-184

Department Allgemeine Innere Medizin, (DAIM) Kliniken Beau Site, Salem und Permanence, Hirslanden, Bern, Switzerland.

With the development of modern EUS, multiple imaging functions, transducer settings, and examination modes have become available for clinical settings. While the major determinants of the ultrasound beam are still comprised of the signal wavelength, its frequency range, and its amplitude, other modifications and calculations have gained more interest for advanced users, such as tissue harmonic imaging (THI), spatial and frequency compounding, certain versions of speckle reduction, and various Doppler/duplex settings. The goal of such techniques is a better, perhaps more realistic image, with reduced artifacts (such as speckle), better image contrast, and an improved signal-to-noise ratio. In addition, "add-ons" such as THI, which is based on the phenomenon of nonlinear distortion of acoustic signals as they travel through tissues, provide greater contrast and an enhanced spatial resolution than conventional EUS. Finally, optimization of spectral and color Doppler imaging in EUS requires experience and knowledge about the basic principles of Doppler/duplex phenomena. For these purposes, factors such as adjustment of Doppler controls, Doppler angle, color gain, spectral wall filters, and others require special attention during EUS examinations. Incorporating these advanced techniques in EUS examinations may be time-consuming and cumbersome. Hence, practical guidelines enabling endosonographers to steer safely through the large quantity of technological properties and settings (knobology) are appreciated. This review provides an overview of the role of important imaging features to be adjusted before, during, and after EUS procedures.
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http://dx.doi.org/10.4103/eus.eus_80_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8248305PMC
March 2021

Ambulatory Use of Handheld Point-of-Care Ultrasound (HH-POCUS) in Rural Brandenburg - A Pilot Study.

Ultraschall Med 2021 Feb 24. Epub 2021 Feb 24.

Institute for Clinical Ultrasound, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany.

Purpose:  This study aims to evaluate the use of handheld ultrasound devices (HHUS) for point-of-care ultrasound (POCUS) to improve outpatient care in rural Brandenburg.

Materials And Methods:  A group of general practitioners (n = 9), palliative care physicians (n = 6), emergency physicians (n = 4), and nurses from palliative care services (n = 5) participated in this study. Following a 3-hour workshop and 2 weeks of individual training, participants performed POCUS using HHUS (HH-POCUS). Indications, examination results, and resulting treatment changes (e. g., acute interventions, new medication) were documented in a standardized data entry form.

Results:  19 physicians with different ultrasound experience and 5 palliative care nurses attended the workshop program and took part in the study. Three of the participating physicians were out of training in ultrasound and received prolonged supervision. Among 427 HH-POCUS examinations, the FAST scan and kidney scan were performed most often. Pain and dyspnea were the most common indications for HH-POCUS. Among the examinations performed by physicians (n = 311), ascites was the most common pathology (27 % of cases). Using a simplified examination protocol, palliative care nurses diagnosed fluid collections, hydronephrosis and transurethral catheter position or urinary retention. In 80.4 % of physician-performed cases, HH-POCUS made a valuable impact on patient management. HH-POCUS contributed to treatment decisions in 49.5 % of cases, including a change of medication in 29.6 % and performance of therapeutic interventions in 19.9 %. Hospital admission or referral to an ambulatory specialist was initiated due to HH-POCUS findings in 17.7 % of patients.

Conclusion:  HH-POCUS helped doctors in rural areas to optimize patient care through rapid on-site collection of therapeutically relevant findings. In addition, it was shown that specialized and motivated nurses can independently detect simple ultrasound findings and thus provide clinically relevant information to doctors.
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http://dx.doi.org/10.1055/a-1354-5958DOI Listing
February 2021

Early detection of pancreatic tumors by advanced EUS imaging.

Minerva Gastroenterol Dietol 2020 Dec 18. Epub 2020 Dec 18.

Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen.

The early detection of pancreatic ductal adenocarcinoma (PDAC) dramatically improves outcome. All available state-of-the-art imaging methods allow early detection with EUS being the best technique for exclusion of PDAC and detection of very early PDAC. Etiological differentiation of small SPL is important to guide individually tailored patients management including radical surgery in resectable PDAC, medical (neoadjuvant or palliative intended) treatment in patients with non-resectable malignancy, pancreatic parenchyma saving strategies in some non-PDAC, and follow-up in particular in low-grade PanNEN or other small benign lesions. Multimodality EUS imaging including B-Mode assessment, elastography, contrast-enhancement and EUS-guided sampling is the most appropriate technique for diagnosis and risk assessment of small SPL. Herewith we present a review discussing modern (endoscopic) ultrasound imaging techniques including contrast enhanced ultrasound and elastography for the early detection and characterization of solid pancreatic lesions.
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http://dx.doi.org/10.23736/S1121-421X.20.02789-0DOI Listing
December 2020

EFSUMB 2020 Proposal for a Contrast-Enhanced Ultrasound-Adapted Bosniak Cyst Categorization - Position Statement.

Ultraschall Med 2021 Apr 11;42(2):154-166. Epub 2020 Dec 11.

Department of Radiology, King's College Hospital London, United Kingdom of Great Britain and Northern Ireland.

The well-established Bosniak renal cyst classification is based on contrast-enhanced computed tomography determining the malignant potential of cystic renal lesions. Ultrasound has not been incorporated into this pathway. However, the development of ultrasound contrast agents coupled with the superior resolution of ultrasound makes it possible to redefine the imaging of cystic renal lesions. In this position statement, an EFSUMB Expert Task Force reviews, analyzes, and describes the accumulated knowledge and limitations and presents the current position on the use of ultrasound contrast agents in the evaluation of cystic renal lesions.
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http://dx.doi.org/10.1055/a-1300-1727DOI Listing
April 2021

Does lymph node morphology using ultrasound reflect aetiology? A pictorial essay, part II, malignant lymphadenopathy.

Med Ultrason 2020 Nov 13;22(4):476-484. Epub 2020 Jun 13.

Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland.

The evaluation of lymph nodes (LN) using ultrasound requires a high level of clinical and sonographic competence. This "pictorial essay" is intended to illustrate eye-catching examples of relevant "clinical-sonographic visual diagnoses" of LNs. We provide typical images and take home messages of eye-catching features to illustrate the featured publications.The first part included the introduction into the subject, indications for US examination and the widely accepted recognized features for LN characterization. The key features for the differential diagnosis of suspected lymphadenopathy and benign lymphadenopathy are illustrated. In the second part eye-catching features of malignant lymphadenopathy and the differential diagnosis of carcinoma and lymphoma are shown.
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http://dx.doi.org/10.11152/mu-2635DOI Listing
November 2020

Does lymph node morphology using ultrasound reflect aetiology? A pictorial essay, part I.

Med Ultrason 2020 Sep;22(3):2634

Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permancence, Bern, Switzerland.

The evaluation of lymph nodes (LNs) using ultrasound requires a high level of clinical and sonographic competence. This "pictorial essay" is intended to illustrate eye-catching examples of relevant "clinical-sonographic visual diagnoses" of LNs. We provide typical images and take-home messages of eye-catching features to illustrate the featured publications.The first part includes "important differential diagnoses of eye-catching features of suspected lymphadenopathy" and "benign lymphadenopathy". The second part will include "Eye-catching features of malignant lymphadenopathy, both carcinoma and lymphoma".
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http://dx.doi.org/10.11152/mu-2634DOI Listing
September 2020

Ultrasound Curricula of Student Education in Europe: Summary of the Experience.

Ultrasound Int Open 2020 Jun 31;6(1):E25-E33. Epub 2020 Aug 31.

Department of Radiological, Oncologic and Anatomo-pathologic Sciences, University of Rome La Sapienza, Roma, Italy.

Despite the increasing role of ultrasound, structured ultrasound teaching is only slowly being integrated into the curricula of medical schools and universities all over Europe. To survey the current situation at European universities regarding the integration of ultrasound in student medical education and to report on models of student ultrasound training from selected European universities. A questionnaire survey focusing on the implementation of curricular ultrasound education was sent out to the 28 presidents of the national ultrasound societies of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), who were asked to distribute the questionnaires to the medical universities of their countries. Overall, 53 questionnaires were returned from 46 universities in 17 European countries. In most of the universities (40/46 universities, 87%), the theoretical background of ultrasound is taught. However, in only a minority of universities is ultrasound integrated in anatomy courses (8/46 universities, 17%) or basic science courses (16/46 universities, 35%). Practical skills in ultrasound are taught in 56% of the universities (26/46 universities) and tested in a practical exam in seven of the responding universities (15%). The number of hours in which ultrasound was taught ranged from one to 58 (mean, seven). The respondents reported that lack of time and limited faculty funding were major hurdles. According to our survey, only a minority of European universities has integrated ultrasound into the preclinical curriculum thus far. Future EFSUMB initiatives will continue to promote the introduction of ultrasound as an integrative part of the core curriculum of student medical education, and the preparation of proper teaching material.
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http://dx.doi.org/10.1055/a-1183-3009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458842PMC
June 2020

Ultrasound Image Optimization ("Knobology"): B-Mode.

Ultrasound Int Open 2020 Jun 31;6(1):E14-E24. Epub 2020 Aug 31.

Department of General Internal Medicine, Hirslanden Clinics Beau Site, Salem and Permanence, Switzerland.

Ultrasound is a ubiquitous and indispensable diagnostic and therapeutic tool in medicine. Due to modern equipment and automatic image optimization, the introduction of ultrasound imaging currently requires only little technical and physical knowledge. However, in-depth knowledge of the device functions and underlying mechanisms is essential for optimal image adjustment and documentation. From a medical as well as an aesthetic point of view, the goal should always be to achieve the best possible image quality. The first part of this article provides an overview of the handling of ultrasound systems, fundamental adjustments, and their optimization in B-mode ultrasound.
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http://dx.doi.org/10.1055/a-1223-1134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458857PMC
June 2020

How to perform EUS-guided tattooing?

Endosc Ultrasound 2020 Sep-Oct;9(5):291-297

Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland.

Recently, we introduced a series of papers describing on how to perform certain techniques and controversies in EUS. In the first paper, "What should be known before performing EUS examinations, Part I," the authors discussed clinical information and whether other imaging modalities should be needed before embarking in EUS examination. In Part II, some technical controversies on how EUS is performed are discussed from different points of view by providing the relevant available evidence. Herewith, we describe on how to perform EUS-guided fine needle tattooing (FNT) in daily practice. The aim of this paper is to discuss pros and cons for several issues including historical remarks, injecting material, technical approach, and how to perform EUS-FNT including argues in favor and against.
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http://dx.doi.org/10.4103/eus.eus_44_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811726PMC
September 2020

An international, multi-institution survey on performing EUS-FNA and fine needle biopsy.

Endosc Ultrasound 2020 Sep-Oct;9(5):319-328

Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Background And Objectives: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and fine needle biopsy (FNB) are effective techniques that are widely used for tissue acquisition. However, it remains unclear how to obtain high-quality specimens. Therefore, we conducted a survey of EUS-FNA and FNB techniques to determine practice patterns worldwide and to develop strong recommendations based on the experience of experts in the field.

Methods: This was a worldwide multi-institutional survey among members of the International Society of EUS Task Force (ISEUS-TF). The survey was administered by E-mail through the SurveyMonkey website. In some cases, percentage agreement with some statements was calculated; in others, the options with the greatest numbers of responses were summarized. Another questionnaire about the level of recommendation was designed to assess the respondents' answers.

Results: ISEUS-TF members developed a questionnaire containing 17 questions that was sent to 53 experts. Thirty-five experts completed the survey within the specified period. Among them, 40% and 54.3% performed 50-200 and more than 200 EUS sampling procedures annually, respectively. Some practice patterns regarding FNA/FNB were recommended.

Conclusion: This is the first worldwide survey of EUS-FNA and FNB practice patterns. The results showed wide variations in practice patterns. Randomized studies are urgently needed to establish the best approach for optimizing the FNA/FNB procedures.
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http://dx.doi.org/10.4103/eus.eus_56_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811723PMC
September 2020

[Quadruple negative SARS-CoV-2-PCR: still COVID-19 pneumonia!]

Dtsch Med Wochenschr 2020 Oct 31;145(20):1498-1502. Epub 2020 Aug 31.

Klinik für Innere Medizin, Krankenhaus Märkisch-Oderland, Strausberg.

Medical History And Clinical Findings:  A 78-year-old man fell ill with weakness, coughing and fever 19 days after a cruise in early April 2020 and was admitted 4 days later with increasing shortness of breath.

Examination And Diagnosis:  On admission, the patient had subfebrile temperatures, exercise dyspnea, and right-basal rales. CRP was moderately elevated and oxygen saturation was slightly reduced. Thoracic CT showed bilateral ground-glass infiltrates. Immediately after the cruise a nasopharyngeal swab was negative for SARS-CoV-2.

Therapy And Course:  Due to the fact that the patient's asymptomatic wife had been tested positive for SARS-CoV-2 immediately after returning from the cruise, we suspected COVID-19 disease and admitted the patient to our isolation ward. Two nasopharyngeal swabs and bronchial lavage yielded negative results for SARS-CoV-2. Finally, suspected COVID-19 diagnosis was verified serologically.

Conclusion:  In case of a high degree of clinical suspicion in combination with typical findings of thoracic imaging, the suspected diagnosis COVID-19 disease should be maintained even in case of multiple negative SARS-CoV-2-PCR. Seroconversion occurs a few days to 2 weeks after the onset of symptoms and can be used to confirm the diagnosis.
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http://dx.doi.org/10.1055/a-1202-3936DOI Listing
October 2020

Guidelines and Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound (CEUS) in the Liver-Update 2020 WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS.

Ultrasound Med Biol 2020 10 24;46(10):2579-2604. Epub 2020 Jul 24.

Center for Cancer Ablation Therapy, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan.

The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast-enhanced ultrasound, first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology. The previous updated editions of the guidelines reflected changes in the available contrast agents and updated the guidelines not only for hepatic but also for non-hepatic applications. The 2012 guideline requires updating as, previously, the differences in the contrast agents were not precisely described and the differences in contrast phases as well as handling were not clearly indicated. In addition, more evidence has been published for all contrast agents. The update also reflects the most recent developments in contrast agents, including U.S. Food and Drug Administration approval and the extensive Asian experience, to produce a truly international perspective. These guidelines and recommendations provide general advice on the use of ultrasound contrast agents (UCAs) and are intended to create standard protocols for the use and administration of UCAs in liver applications on an international basis to improve the management of patients.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2020.04.030DOI Listing
October 2020

Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver - Update 2020 - WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS.

Ultraschall Med 2020 Oct 24;41(5):562-585. Epub 2020 Jul 24.

Center for Cancer Ablation Therapy, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan.

The present, updated document describes the fourth iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS), first initiated in 2004 by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). The previous updated editions of the guidelines reflected changes in the available contrast agents and updated the guidelines not only for hepatic but also for non-hepatic applications.The 2012 guideline requires updating as previously the differences of the contrast agents were not precisely described and the differences in contrast phases as well as handling were not clearly indicated. In addition, more evidence has been published for all contrast agents. The update also reflects the most recent developments in contrast agents, including the United States Food and Drug Administration (FDA) approval as well as the extensive Asian experience, to produce a truly international perspective.These guidelines and recommendations provide general advice on the use of ultrasound contrast agents (UCA) and are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis to improve the management of patients.
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http://dx.doi.org/10.1055/a-1177-0530DOI Listing
October 2020

Do we need elastography for EUS?

Endosc Ultrasound 2020 Sep-Oct;9(5):284-290

Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen; Brandenburg Institute of Clinical Ultrasound, Medical University Brandenburg, Neuruppin, Germany.

We recently introduced a series of papers "What should be known prior to performing EUS exams." In Part I, the authors discussed which clinical information and whether other imaging modalities are needed before embarking EUS examinations. In Part II, technical controversies on how EUS is performed were discussed from different points of view. In this article, important practical issues regarding EUS elastography will be raised and controversially discussed from very different points of view.
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http://dx.doi.org/10.4103/eus.eus_25_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811716PMC
July 2020

Do we need contrast agents for EUS?

Endosc Ultrasound 2020 Nov-Dec;9(6):361-368

Johann Wolfgang Goethe University Frankfurt, Germany; Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China; Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland.

We recently introduced a series of articles that dealt with controversies in EUS. In Part I, the authors discussed which clinical information is necessary prior to EUS and whether other imaging modalities are required before embarking on EUS examinations. Part II focuses on technical details and controversies about the use of EUS in special situations. In this article, important practical issues regarding the application of contrast-enhanced EUS in various clinical settings are raised and controversially discussed from different points of view.
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http://dx.doi.org/10.4103/eus.eus_20_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811706PMC
July 2020

Commentary on the World Federation for Ultrasound in Medicine and Biology Project "Incidental Findings".

Ultrasound Med Biol 2020 07 12;46(7):1815-1820. Epub 2020 May 12.

Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen and Brandenburg Institute for Clinical Ultrasound, Neuruppin, Germany.

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http://dx.doi.org/10.1016/j.ultrasmedbio.2020.02.002DOI Listing
July 2020

Modern ultrasound imaging of pancreatic tumors.

Ultrasonography 2020 Apr 27;39(2):105-113. Epub 2019 Aug 27.

Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen and Brandenburg Institute for Clinical Ultrasound, Neuruppin, Germany.

In patients with solid pancreatic lesions (SPLs), the differential diagnosis must be evaluated to determine whether radical surgery, pancreatic parenchyma-saving strategies, or follow-up is indicated. Contrast-enhanced (endoscopic) ultrasonography and elastography facilitate the further characterization of SPLs. The majority of cases of pancreatic ductal adenocarcinoma exhibit hypoenhancement with contrast-enhanced ultrasonography. Elastographically soft SPLs are benign with very few exceptions, whereas stiffer SPLs can be malignant or benign. This article reviews the current use of modern ultrasound imaging techniques, including contrast-enhanced ultrasonography and elastography, for the detection and characterization of SPLs. In particular, the unexcelled diagnostic potential of multiparametric endoscopic ultrasonography to detect and characterize small SPLs is highlighted.
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http://dx.doi.org/10.14366/usg.19039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7065990PMC
April 2020

WFUMB position paper on the management incidental findings: adrenal incidentaloma.

Ultrasonography 2020 Jan 9;39(1):11-21. Epub 2019 Jul 9.

Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg/Wriezen and Brandenburg Institute for Clinical Ultrasound, Neuruppin, Germany.

Focal lesions of the adrenal glands are incidentally detected in approximately 5% of cases by modern imaging techniques. Fewer than 5% of these adrenal incidentalomas are malignant and approximately 10% have endocrine activity. Reliable differentiation of malignant versus benign and hormonally active versus nonfunctional adrenal incidentalomas significantly influences therapeutic management and the outcome of affected individuals. Therefore, each adrenal incidentaloma should undergo a standardized diagnostic work-up to exclude malignancy and endocrine activity. This position statement of the World Federation of Ultrasound in Medicine and Biology (WFUMB) summarizes the available evidence on the management of adrenal incidentaloma and describes efficient management strategies with particular reference to the role of ultrasound techniques.
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http://dx.doi.org/10.14366/usg.19029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6920619PMC
January 2020

What should be known prior to performing EUS exams? (Part II).

Endosc Ultrasound 2019 Nov-Dec;8(6):360-369

Division of Gastroenterology, Endosonography and Advanced Therapeutic Endoscopy, The American University of Beirut, Medical Center, Beirut, Lebanon.

In "What should be known prior to performing EUS exams, Part I," the authors discussed the need for clinical information and whether other imaging modalities are required before embarking EUS examinations. Herewith, we present part II which addresses some (technical) controversies how EUS is performed and discuss from different points of view providing the relevant evidence as available. (1) Does equipment design influence the complication rate? (2) Should we have a standardized screen orientation? (3) Radial EUS versus longitudinal (linear) EUS. (4) Should we search for incidental findings using EUS?
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http://dx.doi.org/10.4103/eus.eus_57_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927139PMC
October 2019

Changes in tumor vascularity depicted by contrast-enhanced EUS as a predictor of prognosis and treatment efficacy in patients with unresectable pancreatic cancer (PEACE): A study protocol.

Endosc Ultrasound 2019 Jul-Aug;8(4):235-240

Carilion Clinic Roanoke, Roanoke, USA.

Patients with unresectable pancreatic cancer have a poor prognosis. The analysis of prognostic factors before treatment may be helpful in determining the best therapeutic strategies. The aim of the PEACE study is to assess the vascularity of pancreatic malignant tumors using contrast-enhanced harmonic EUS (CEH-EUS) and to clarify the prognostic value of tumor vascularity in patients with locally advanced and metastatic pancreatic cancer. Hereby, we present the protocol of a prospective, nonrandomized, single-arm, multicenter study aiming to assess changes in tumor vascularity using CEH-EUS before and 2 months after treatment initiation in patients with unresectable, locally advanced/metastatic pancreatic cancer and to examine the correlation between vascular changes and treatment response, progression-free survival, and overall survival.
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http://dx.doi.org/10.4103/eus.eus_16_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6714481PMC
June 2019