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Nice pictures, but so what? ▸

In an ideal world, we would use evidence from randomised controlled trials to inform our endoscopic practice. Such trials are however often impossible or prohibitively expensive to perform, yet outcomes research demands we demonstrate the benefits of new technologies. Endoscopic ultrasound (EUS) is a case in point, its niche in endoscopy seemingly already established. This study prospectively examined the impact of EUS with or without fine needle aspiration in a cohort of 330 consecutively referred patients. Using structured pre- and post-EUS questionnaires, referring clinicians were asked about diagnosis, further investigations, and management plans. Results were available for 233 patients (70%) across a broad range of conditions, including cancer staging, gastric wall abnormalities, mediastinal masses, and pancreaticobiliary disease. EUS, accurate in 88% of verified cases, led to a change in diagnosis in 26% of cases, examples being the nature of gastric submucosal lesions, suspected ampullary masses, or chronic pancreatitis and …

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