However, none of the biopsy technologies resulted in bleeding that did not stop spontaneously. Another major concern and potential limitation of the current CB design is the relatively click here large diameter of the probe. Such a large probe in conjunction with a freezing biopsy technique could be associated with an increased risk for pancreatitis. This is an important concern that will need to be addressed in further survival experiments before clinical introduction.

Because expansion of a gas inside a hollow probe is necessary to generate sufficient cooling for biopsy extraction (Joule-Thomson effect), the diameter of the CB probe used in this study was 18 gauge. To allow for fair comparison between technologies, a 19-gauge FNA and an 18-gauge TC probe were used. However, in the clinical setting, 22-gauge or 25-gauge probes are routinely used for EUS-FNA. This warrants further technical engineering to decrease the probe size for CB. In conclusion, this study demonstrated that CB obtains superior histology specimens compared with those of FNA. Further technical refinements could make this new biopsy probe a valuable tool for EUS tissue sampling in the future. Clinical studies will

then be GW-572016 clinical trial necessary to elucidate potential added value in the diagnosis of pancreatic lesions, lymph nodes, and subepithelial tumors. “
“Endoscopic sphincterotomy (ES) has become well established since Cediranib (AZD2171) it was first reported in 1974.1 and 2 Although ES is used for the vast majority of cases to facilitate removal

of bile duct stones, complications of ES include bleeding, pancreatitis, and perforation.3 and 4 Several in vivo and ex vivo training simulators that use animal models and mechanical and computer-based simulators are available for education in diagnostic and therapeutic ERCP.5, 6, 7, 8, 9, 10, 11 and 12 The use of live pigs allows for more realistic diagnostic and therapeutic ERCP, such as biliary cannulation, ES, and stent placement than computer-based simulators. This facilitates acquisition of basic ERCP-related procedural skills. With regard to ES, however, the papilla of the pig is anatomically different from that of humans because of a small orifice and the lack of bulging and papillary roof. Furthermore, a live pig for ES training is limited because it can only be used for 1 complete sphincterotomy. Ideal ES training models should (1) provide more realistic tactile sensation when cutting the papilla and (2) allow repeat ES procedures with the need for fewer pigs. Interestingly, Matthes and Cohen10 created a “neo-papilla” by using a chicken heart and porcine splenic/iliac artery vessels to more closely approximate the human anatomy because it does not have to be replaced after each sphincterotomy but may be rotated multiple times before changing.