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Endoscopic Ultrasound-Guided Diagnosis and Treatment of Gastrointestinal Diseases

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (21 August 2023) | Viewed by 31593

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Dr. Manol Jovani

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Department of Gastroenterology, Maimonides Medical Center, SUNY Downstate University, Brooklyn, NY, USA
Interests: interventional EUS; ERCP; third space endoscopy; bariatric endoscopy; new technologies

Special Issue Information

Dear Colleagues,

It is with great pleasure that I invite you to contribute to this exciting Special Issue on “Endoscopic Ultrasound-Guided Diagnosis and Treatment of Gastrointestinal Diseases”.

The endoscopic ultrasound (EUS) started as a simple diagnostic methodology nearly five decades ago, and has since become an indispensable tool for the diagnosis and management of numerous gastrointestinal pathologies.

As a diagnostic tool, the EUS has become an integral component of the staging of gastroesophageal and biliopancreatic neoplasia, histologic sampling of upper and lower gastrointestinal lesions/periluminal masses, screening of pancreatic cancer, and, more recently, of the development of the new field of endo-hepatology. New accessories have been invented or improved upon, significantly increasing the diagnostic yield of the EUS, including the introduction of new types of needles and an increased utilization of elastography and the contrast-enhanced EUS. Artificial intelligence has seen a dramatic increase in utilization in luminal endoscopy, and new models of AI are currently being applied to EUS to further increase its diagnostic capabilities.

Considering that with the EUS transducer we can easily access organs adjacent to the gastrointestinal tract, it was simply a matter of time before EUS became interventional, as it did in the early 1990s. Since then, the scope and range of EUS-guided interventions has dramatically increased, extending from EUS-assisted rendez-vous ERCP, EUS-guided celiac plexus block/neurolysis and fiducial placement, EUS-guided biliary and pancreatic drainage—both in regular and altered anatomy— to the treatment of cysts and solid lesions in the pancreas/liver with EUS-guided local therapies (such as the EUS-guided injection of antitumoral agents/immunotherapy or EUS-guided ablative techniques), EUS-guided coiling/glue injection for gastric varices, and EUS-guided drainage of abdominopelvic collections. The introduction of lumen-apposing metal stents (LAMS) revolutionized the therapeutic capabilities of EUS, by allowing the creation of new gastrointestinal anastomoses. This, in turn, made possible interventions that previously were a part of the surgical or interventional radiology realm, such as EUS-guided cystogastrostomy (EUS-CG)/endoscopic necrosectomy, EUS-guided gastroenterostomy (EUS-GE), EUS-guided gallbladder drainage (EUS-GD), EUS-directed transgastric ERCP (EGDE), and EUS-directed transenteric ERCP (EDEE), etc.

These and many other tremendous advances, too many to enumerate in a short paragraph, make diagnostic and therapeutic EUS a very exciting field. However, evidence for much of what is performed in clinical practice is usually of poor quality, based often on retrospective studies or expert opinion, leaving many questions unanswered. Many projects are currently ongoing, aiming to provide much-needed evidence, including the utility of new technologies and accessories to increase the diagnostic yield of EUS, as well as the development of dedicated specialized accessories and the standardization of procedures for therapeutic EUS.

This Special Issue of the JCM journal is dedicated to the publication of articles answering some of these questions and reviewing the available evidence for diagnostic and therapeutic EUS techniques. I am sure that you will join me in my enthusiasm for this extremely exciting project and I look forward to receiving your contributions.

Dr. Manol Jovani
Guest Editor

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Keywords

pancreatobiliary disease
diagnostic EUS
contrast-enhanced EUS
endo-hepatology
interventional EUS
EUS-guided biliary and pancreatic drainage
EUS-guided local therapies
lumen-apposing metal stents
new technologies
artificial intelligence

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Published Papers (12 papers)

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Research

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10 pages, 1182 KiB

Open AccessArticle

Secondary Tumors of the Pancreas: A Multicenter Analysis of Clinicopathological and Endosonographic Features

by Marco Spadaccini, Maria Cristina Conti Bellocchi, Benedetto Mangiavillano, Alberto Fantin, Daoud Rahal, Erminia Manfrin, Francesca Gavazzi, Silvia Bozzarelli, Stefano Francesco Crinò, Maria Terrin, Milena Di Leo, Cristiana Bonifacio, Antonio Facciorusso, Stefano Realdon, Chiara Cristofori, Francesco Auriemma, Alessandro Fugazza, Luca Frulloni, Cesare Hassan, Alessandro Repici and Silvia Carrara Show full author list Hide full author list

J. Clin. Med. 2023, 12(8), 2829; https://doi.org/10.3390/jcm12082829 - 12 Apr 2023

Cited by 8 | Viewed by 1725

Abstract

Many tumors may secondarily involve the pancreas; however, only retrospective autopic and surgical series are available. We retrospectively collected data from all consecutive patients with histologically confirmed secondary tumors of the pancreas referred to five Italian centers between 2010 and 2021. We described clinical and pathological features, therapeutic approach and treatment outcomes. EUS characteristics of the lesions and the tissue acquisition procedures (needle, passages, histology) were recorded. A total of 116 patients (males/females 69/47; mean age 66.7) with 236 histologically confirmed pancreatic metastases were included; kidney was the most common primary site. EUS was performed to confirm the diagnosis in 205 lesions which presented as predominantly solitary (59), hypoechoic (95) and hypervascular (60), with a heterogeneous (n = 54) pattern and well-defined borders (n = 52). EUS-guided tissue acquisition was performed in 94 patients with an overall accuracy of 97.9%. Histological evaluation was possible in 88.3% of patients, obtaining final diagnosis in all cases. When cytology alone was performed, the final diagnosis was obtained in 83.3% of cases. A total of 67 patients underwent chemo/radiation therapy, and surgery was attempted in 45 (38.8%) patients. Pancreatic metastases are a possible event in the natural history of solid tumors, even long after the diagnosis of the primary site. EUS-guided fine needle biopsy may be suggested to implement the differential diagnosis. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Diagnosis and Treatment of Gastrointestinal Diseases)

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9 pages, 503 KiB

Open AccessArticle

The Efficacy and Safety of EUS-Guided Gallbladder Drainage as a Bridge to Surgery for Patients with Acute Cholecystitis

by Ken Ishii, Yuji Fujita, Eisuke Suzuki, Yuji Koyama, Seitaro Tsujino, Atsuki Nagao, Kunihiro Hosono, Takuma Teratani, Kensuke Kubota and Atsushi Nakajima

J. Clin. Med. 2023, 12(8), 2778; https://doi.org/10.3390/jcm12082778 - 8 Apr 2023

Cited by 1 | Viewed by 2110

Abstract

Background and Aim: This study aimed to compare the efficacy and safety of endoscopic ultrasound-guided gallbladder drainage and percutaneous transhepatic gallbladder drainage as a bridge to surgery in patients with acute cholecystitis unfit for urgent cholecystectomy. Methods: This retrospective study included 46 patients who underwent cholecystectomy following endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) or percutaneous transhepatic gallbladder drainage (PTGBD) for acute cholecystitis in NTT Tokyo Medical Center. We surveyed 35 patients as the EUS-GBD group and 11 patients as the PTGBD group, and compared the rate of technical success of the cholecystectomy and periprocedural adverse events. A 7-F, 10-cm double pigtail plastic stent was used for ultrasound-guided gallbladder drainage. Results: The rate of technical success of cholecystectomy was 100% in both groups. Regarding postsurgical adverse events, no significant difference was noted between the two groups (EUS-GBD group, 11.4%, vs. PTGBD group, 9.0%; p = 0.472). Conclusions: EUS-GBD as a BTS seems to be an alternative for patients with AC because it can ensure lower adverse events. On the other hand, there are two major limitations in this study––the sample size is small and there is a risk of selection bias. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Diagnosis and Treatment of Gastrointestinal Diseases)

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10 pages, 480 KiB

Open AccessArticle

Reduction of Lams-Related Adverse Events with Accumulating Experience in a Large-Volume Tertiary Referral Center

by Sebastian Stefanovic, Helena Degroote and Pieter Hindryckx

J. Clin. Med. 2023, 12(3), 1037; https://doi.org/10.3390/jcm12031037 - 29 Jan 2023

Cited by 4 | Viewed by 1673

Abstract

Background and aims: Lumen-apposing metal stents (LAMSs) are increasingly used both for on- and off-label indications. We continuously adapt our step-by-step protocol to optimize the safe deployment of LAMSs for the different indications. The aim of this study was to evaluate the impact of this approach over time. Methods: We conducted a single-center study on consecutive patients who underwent LAMS placement for on- and off-label indications between June 2020 and June 2022. Endpoints included technical success, clinical success and adverse event rates. We compared the results with our previously published early experience with LAMSs (N = 61), between March 2018 and May 2020. Results: This cohort consisted of 168 LAMSs in 153 patients. Almost half of them (47.6%) were placed for off-label indications (gastro-enterostomy, temporary access to the excluded stomach in patients with previous gastric bypass, drainage of postsurgical collections, stenting of short refractory gastrointestinal strictures). While the technical and clinical success rates were similar to those in our previously published cohort (97% and 93.5% versus 93.4% and 88.5%, respectively), the adverse event rate dropped from 21.3% to 8.9%. Conclusions: Our results demonstrate the impact of a learning curve in LAMS placement, with a clinically relevant drop in LAMS-related adverse events over time. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Diagnosis and Treatment of Gastrointestinal Diseases)

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6 pages, 5930 KiB

Open AccessArticle

Endoscopic Ultrasound-Guided Botox Injection for Refractory Anal Fissure

by Navkiran Randhawa, Ahamed Khalyfa, Rida Aslam, M. Christopher Roebuck, Mahnoor Inam and Kamran Ayub

J. Clin. Med. 2022, 11(20), 6207; https://doi.org/10.3390/jcm11206207 - 21 Oct 2022

Cited by 2 | Viewed by 2901

Abstract

Background: Anal fissures cause severe pain and can be difficult to treat. Medical therapy is initially used, followed by sigmoidoscopy-guided botox injections if the medical therapy is not successful. With this technique, however, it is not clear whether botox is injected into the muscle layer or submucosa. Aim: To evaluate the efficacy of EUS-guided botox injection directly into the internal sphincter. Methods: Consecutive patients with chronic anal fissure refractory to conventional endoscopic botulinum toxin type A injection were enrolled in the study. EUS was performed using a linear array echoendoscope, and a 25 G needle was used to inject botox. All patients were followed up at one- and two-month intervals. Results: Eight patients with chronic anal fissures were included in the study. Six patients had an excellent response to botox at the two-month interval using a visual analog pain scale, while one patient had a moderate response with a pain score reduction of 40%. One patient had no response. No complications were noted. An improvement in visual analog scale (pre-score > post-score) was statistically significant at the p < 0.01 level. Conclusion: EUS-guided botox injection into the internal sphincter appears to be a promising technique for patients with refractory anal fissure with pain. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Diagnosis and Treatment of Gastrointestinal Diseases)

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Review

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12 pages, 767 KiB

Open AccessReview

A Comparison of Single Dimension and Volume Measurements in the Risk Stratification of Pancreatic Cystic Lesions

by Da Yeon Ryoo, Bryn Koehler, Jennifer Rath, Zarine K. Shah, Wei Chen, Ashwini K. Esnakula, Phil A. Hart and Somashekar G. Krishna

J. Clin. Med. 2023, 12(18), 5871; https://doi.org/10.3390/jcm12185871 - 9 Sep 2023

Viewed by 1533

Abstract

The incidence of pancreatic cystic lesions (PCLs) has been rising due to improvements in imaging. Of these, intraductal papillary mucinous neoplasms (IPMNs) are the most common and are thought to contribute to almost 20% of pancreatic adenocarcinomas. All major society guidelines for the management of IPMNs use size defined by maximum diameter as the primary determinant of whether surveillance or surgical resection is recommended. However, there is no consensus on how these measurements should be obtained or whether a single imaging modality is superior. Furthermore, the largest diameter may fail to capture the complexity of PCLs, as most are not perfectly spherical. This article reviews current PCL measurement techniques in CT, MRI, and EUS and posits volume as a possible alternative to the largest diameter. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Diagnosis and Treatment of Gastrointestinal Diseases)

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23 pages, 3402 KiB

Open AccessReview

The Latest Advancements in Diagnostic Role of Endosonography of Pancreatic Lesions

by Jagoda Oliwia Rogowska, Łukasz Durko and Ewa Malecka-Wojciesko

J. Clin. Med. 2023, 12(14), 4630; https://doi.org/10.3390/jcm12144630 - 12 Jul 2023

Cited by 6 | Viewed by 2292

Abstract

Endosonography, a minimally invasive imaging technique, has revolutionized the diagnosis and management of pancreatic diseases. This comprehensive review highlights the latest advancements in endosonography of the pancreas, focusing on key technological developments, procedural techniques, clinical applications and additional techniques, which include real-time elastography endoscopic ultrasound, contrast-enhanced-EUS, EUS-guided fine-needle aspiration or EUS-guided fine-needle biopsy. EUS is well established for T-staging and N-staging of pancreaticobiliary malignancies, for pancreatic cyst discovery, for identifying subepithelial lesions (SEL), for differentiation of benign pancreaticobiliary disorders or for acquisition of tissue by EUS-guided fine-needle aspiration or EUS-guided fine-needle biopsy. This review briefly describes principles and application of EUS and its related techniques. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Diagnosis and Treatment of Gastrointestinal Diseases)

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21 pages, 363 KiB

Open AccessReview

Endoscopic Ultrasound-Guided Local Ablative Therapies for the Treatment of Pancreatic Neuroendocrine Tumors and Cystic Lesions: A Review of the Current Literature

by Alexander M. Prete and Tamas A. Gonda

J. Clin. Med. 2023, 12(9), 3325; https://doi.org/10.3390/jcm12093325 - 7 May 2023

Cited by 6 | Viewed by 3190

Abstract

Since its emergence as a diagnostic modality in the 1980s, endoscopic ultrasound (EUS) has provided the clinician profound access to gastrointestinal organs to aid in the direct visualization, sampling, and subsequent identification of pancreatic pathology. In recent years, advancements in EUS as an interventional technique have promoted the use of local ablative therapies as a minimally invasive alternative to the surgical management of pancreatic neuroendocrine tumors (pNETs) and pancreatic cystic neoplasms (PCNs), especially for those deemed to be poor operative candidates. EUS-guided local therapies have demonstrated promising efficacy in addressing a spectrum of pancreatic neoplasms, while also balancing local adverse effects on healthy parenchyma. This article serves as a review of the current literature detailing the mechanisms, outcomes, complications, and limitations of EUS-guided local ablative therapies such as chemical ablation and radiofrequency ablation (RFA) for the treatment of pNETs and PCNs, as well as a discussion of future applications of EUS-guided techniques to address a broader scope of pancreatic pathology. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Diagnosis and Treatment of Gastrointestinal Diseases)

8 pages, 232 KiB

Open AccessReview

Endoscopic Ultrasound-Guided Biliary Drainage

by John B. Doyle and Amrita Sethi

J. Clin. Med. 2023, 12(7), 2736; https://doi.org/10.3390/jcm12072736 - 6 Apr 2023

Cited by 6 | Viewed by 3829

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) are currently first- and second-line therapeutic options, respectively, for the relief of biliary obstruction. In recent years, however, endoscopic ultrasound-guided biliary drainage (EUS-BD) has become an established alternative therapy for biliary obstruction. There are multiple different techniques for EUS-BD, which can be distinguished based on the access point within the biliary tree (intrahepatic versus extrahepatic) and the location of stent placement (transenteric versus transpapillary). The clinical and technical success rates of biliary drainage for EUS-BD are similar to both ERCP and PTBD, and complication rates are favorable for EUS-BD relative to PTBD. As EUS-BD becomes more widely practiced and endoscopic tools continue to advance, the outcomes will likely improve, and the breadth of indications for EUS-BD will continue to expand. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Diagnosis and Treatment of Gastrointestinal Diseases)

14 pages, 2351 KiB

Open AccessReview

EUS-Guided Vascular Interventions

by Michelle Baliss, Devan Patel, Mahmoud Y. Madi and Ahmad Najdat Bazarbashi

J. Clin. Med. 2023, 12(6), 2165; https://doi.org/10.3390/jcm12062165 - 10 Mar 2023

Cited by 3 | Viewed by 2728

Abstract

Endoscopic ultrasound (EUS) has numerous advanced applications as a diagnostic and therapeutic modality in contemporary medicine. Through intraluminal placement, EUS offers a real-time Doppler-guided endoscopic visualization and access to intra-abdominal vasculature, which were previously inaccessible using historical methods. We aim to provide a comprehensive review of key studies on both current and future EUS-guided vascular applications. This review details EUS-based vascular diagnostic techniques of portal pressure measurements in the prognostication of liver disease and portal venous sampling for obtaining circulating tumor cells in the diagnosis of cancer. From an interventional perspective, we describe effective EUS-guided treatments via coiling and cyanoacrylate injections of gastric varices and visceral artery pseudoaneurysms. Specific attention is given to clinical studies on efficacy and procedural techniques described by investigators for each EUS-based application. We explore novel and future emerging EUS-based interventions, such as liver tumor ablation and intrahepatic portosystemic shunt placement. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Diagnosis and Treatment of Gastrointestinal Diseases)

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14 pages, 846 KiB

Open AccessReview

Techniques and Outcomes of Endoscopic Ultrasound Guided—Pancreatic Duct Drainage (EUS- PDD)

by Jun Liang Teh and Anthony Yuen Bun Teoh

J. Clin. Med. 2023, 12(4), 1626; https://doi.org/10.3390/jcm12041626 - 17 Feb 2023

Cited by 6 | Viewed by 2536

Abstract

Endoscopic ultrasound guided—pancreatic duct drainage (EUS- PDD) is one of the most technically challenging procedures for the interventional endoscopist. The most common indications for EUS- PDD are patients with main pancreatic duct obstruction who have failed conventional endoscopic retrograde pancreatography (ERP) drainage or those with surgically altered anatomy. EUS- PDD can be performed via two approaches: the EUS-rendezvous (EUS- RV) or the EUS-transmural drainage (TMD) techniques. The purpose of this review is to provide an updated review of the techniques and equipment available for EUS- PDD and the outcomes of EUS- PDD reported in the literature. Recent developments and future directions surrounding the procedure will also be discussed. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Diagnosis and Treatment of Gastrointestinal Diseases)

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15 pages, 832 KiB

Open AccessReview

Artificial Intelligence in Endoscopic Ultrasound for Pancreatic Cancer: Where Are We Now and What Does the Future Entail?

by Dushyant Singh Dahiya, Mohammad Al-Haddad, Saurabh Chandan, Manesh Kumar Gangwani, Muhammad Aziz, Babu P. Mohan, Daryl Ramai, Andrew Canakis, Jay Bapaye and Neil Sharma

J. Clin. Med. 2022, 11(24), 7476; https://doi.org/10.3390/jcm11247476 - 16 Dec 2022

Cited by 13 | Viewed by 3807

Abstract

Pancreatic cancer is a highly lethal disease associated with significant morbidity and mortality. In the United States (US), the overall 5-year relative survival rate for pancreatic cancer during the 2012–2018 period was 11.5%. However, the cancer stage at diagnosis strongly influences relative survival in these patients. Per the National Cancer Institute (NCI) statistics for 2012–2018, the 5-year relative survival rate for patients with localized disease was 43.9%, while it was 3.1% for patients with distant metastasis. The poor survival rates are primarily due to the late development of clinical signs and symptoms. Hence, early diagnosis is critical in improving treatment outcomes. In recent years, artificial intelligence (AI) has gained immense popularity in gastroenterology. AI-assisted endoscopic ultrasound (EUS) models have been touted as a breakthrough in the early detection of pancreatic cancer. These models may also accurately differentiate pancreatic cancer from chronic pancreatitis and autoimmune pancreatitis, which mimics pancreatic cancer on radiological imaging. In this review, we detail the application of AI-assisted EUS models for pancreatic cancer detection. We also highlight the utility of AI-assisted EUS models in differentiating pancreatic cancer from radiological mimickers. Furthermore, we discuss the current limitations and future applications of AI technology in EUS for pancreatic cancers. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Diagnosis and Treatment of Gastrointestinal Diseases)

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11 pages, 11894 KiB

Open AccessReview

Role of Endoscopy in Esophageal Tuberculosis: A Narrative Review

by Tong Ye, Ye Zong, Guiping Zhao, Anni Zhou, Bing Yue, Haiying Zhao and Peng Li

J. Clin. Med. 2022, 11(23), 7009; https://doi.org/10.3390/jcm11237009 - 27 Nov 2022

Cited by 2 | Viewed by 1838

Abstract

Esophageal tuberculosis (ET) is a rare infectious disease of the gastrointestinal tract. Awareness of ET is deficient due to its low incidence. Unexplained dysphagia and upper gastrointestinal bleeding are the most common symptoms of ET. The prognosis is generally good if patients are diagnosed properly and receive anti-tubercular treatment promptly. However, ET is difficult to differentiate from other diseases. Endoscopic techniques such as esophagogastroduodenoscopy (EGD), endoscopic ultrasonography (EUS), contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS), elastography, and endoscopic ultrasound--guided fine-needle aspiration (EUS-FNA) improve the diagnosis of ET. Thus, the characteristics of ET and other difficult-to-detect diseases according to EGD and EUS were summarized. Intriguingly, there is no literature relevant to the application of CH-EUS and elastography in ET. The authors’ research center was first in introducing CH-EUS and elastography into the field of ET. The specific manifestation of ET based on CH-EUS was discovered for the first time. Correlative experience and representative cases were shared. The role of endoscopy in acquiring esophageal specimens and treatment for ET was also established. In this review, we aim to introduce a promising technology for the diagnosis and treatment of ET. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Diagnosis and Treatment of Gastrointestinal Diseases)

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