EUS-guided gastroenterostomy (EUS-GE) is rapidly emerging as a pivotal procedure in the management of gastric outlet obstruction due to its advantages over historical comparators such as surgical gastroenterostomy and endoscopic placement of gastroduodenal stents. The ability to create a stable surgical-range connection between 2 lumens, distant from the tumor, with the minimally invasive nature of an endoscopic procedure, offers high clinical efficacy, acceptable safety, and low recurrence rates. However, widespread adoption is impeded by the steep learning curve and lack of standardized methodologies. Like other interventional EUS procedures, EUS-GE utilizes lumen apposing metal stents. Unlike drainage procedures, the target in EUS-GE is a mobile structure with a virtual resting caliber that needs to be distended to create the connection, making misdeployment a significant drawback. This comprehensive illustrated technical review dissects the general and specific technical principles of EUS-GE covering the equipment, scene, settings, and endoscopic signs of correct and incorrect placement. It provides a deeper insight into the wireless simplified EUS-GE technique, the EUS-guided double-balloon-occluded gastrojejunostomy bypass, and the direct technique. Through pragmatic tips, expert advice, and elucidative step-by-step videos, a systematic roadmap for mastering this intricate procedure is presented. By addressing common challenges and providing troubleshooting strategies, this review aims to demystify EUS-GE, equipping practitioners with the tools to achieve reproducible and optimal outcomes.
In this study, we evaluated the performance of FT-IR spectroscopy for clonality assessment of Serratia marcescens by comparing its clustering output to that of whole-genome sequencing (WGS), using core genome single nucleotide polymorphism (cgSNP) analysis as reference. A genetically diverse set of Serratia marcescens clinical isolates was collected from different hospitals in Belgium and measured with FT-IR spectroscopy in biological triplicate to assess reproducibility and in turn build a robust reference set. WGS data of the isolates was available and used to assess the performance of FT-IR spectroscopy. FT-IR spectroscopy showed good overall concordance with WGS (Adjusted Rand Index [ARI] of 0.755), but the level of agreement was insufficient to support the use of a single fixed cut-off value (COV) for clinical outbreak interpretation. To address this, a standardized workflow was developed incorporating multiple COVs to interpret clustering with varying level of confidence. This approach was validated using three unrelated S. marcescens outbreak case studies in neonatal intensive care units. The workflow yielded clustering results that matched WGS-based analyses and allowed clonality assessments within 24 h after isolate recovery. In conclusion, FT-IR spectroscopy can serve as a first-line screening tool to rapidly identify clonal clusters of S. marcescens, reducing turnaround time and limiting the number of isolates requiring confirmatory WGS, thereby considerably lowering overall outbreak investigation costs.
The percutaneous placement of iliosacral (IS) and transsacral (TS) screws has become a standard practice for the treatment of pelvic fractures. Due to the complex sacral anatomy, accurate screw placement is essential to avoid complications, such as neurovascular injury. The goal of this study was to quantify the deviation between planned and executed screw trajectories and to identify associated factors. We conducted a retrospective cohort study on treating 51 patients with pelvic fractures from August 2021 to December 2023, using a total of 95 IS and TS screws. Preoperative planning was performed to generate a volume-rendered reconstruction that replicates standard intraoperative fluoroscopic views (lateral, inlet, outlet). These simulated images served as references during surgery. Postoperative Computed Tomography (CT) data were integrated with the preoperative plan to quantify screw deviations through accuracy metrics. Median deviation from the planned entry point was 8.8 mm (6.2–12.8) for IS and 6.2 mm (4.2–9.0) for TS. Average distances were 5.7 mm (3.5–8.0) for IS and 4.8 mm ± 2.0 for TS. Angle deviation was 8.2° (4.6–12.8) for IS and 3.9° ± 1.8 for TS. One patient experienced loss of sensibility due to an IS screw conflicting with the L5 nerve root, needing revision surgery. A positive association was observed between BMI and the distance between entry points for TS screws. Learning curve analysis showed no significant change in accuracy over time. Preoperative navigation using volume-rendered virtual imaging could not guarantee a precise positioning of IS and TS screws. Although geometric deviations were observed between planned and placed screws, clinical outcomes were favourable, with a very low complication rate. The technique proved feasible and safe in clinical practice, achieving moderate overall accuracy, and may therefore be particularly valuable for less-experienced surgeons.
Trans-arterial radioembolization (TARE) is established as a treatment for colorectal liver metastases and may also be beneficial in other tumour entities. This prospective analysis aimed to evaluate the safety and effectiveness of TARE in patients with liver metastases of non-colorectal origin. Data were extracted from the prospective, multicentre, observational CIRSE Registry for SIR-Spheres Therapy (CIRT). Adult patients with liver metastases of non-colorectal origin, including neuroendocrine tumours (NET), breast cancer, pancreatic cancer and melanoma treated with TARE Yttrium-90 resin microspheres, were included. Safety and survival analyses were conducted. Assessment for independent prognostic factors was conducted using Cox proportional hazards models. Adverse events were defined according to the CTCAE 4.03. A total of 169 patients underwent TARE: NET (n = 58), breast cancer (n = 47), pancreatic cancer (n = 32), and melanoma (n = 32) with median follow-up of 19.3, 9.6, 5.6 and 14.8 months, respectively. Median overall survival (OS) was 33.3 (22.4-NA), 10.7 (7.7–16.3), 5.6 (4.9–10.1), 14.7 (8.7–27) months, for the NET, breast cancer, pancreatic cancer and melanoma cohorts, respectively. Overall, severe adverse events (grade ≥ 3) occurred in 10
The use of standardised structured radiology reports improves the consistency, reproducibility and overall quality of radiological reporting while enhancing communication with referring physicians and ultimately contributing to improved patient care. To develop a standardised structured report template for foetal and neonatal postmortem magnetic resonance imaging through expert consensus. A Delphi survey was conducted between September and December 2025 among members of the ESPR Postmortem Task Force and other recommended international PM imaging experts. The surveyed items were derived from clinically used MRI reporting templates across the expert group. Consensus was defined using a ≥75
