{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T19:59:04Z","timestamp":1792180744015,"version":"4.4.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T00:00:00Z","timestamp":1605052800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In congenital hyperinsulinism (CHI), preoperative prediction of the histological subtype (focal, diffuse, or atypical) relies on genetics and 6-[18F]fluoro-l-3,4-dihydroxyphenylalanine (18F-DOPA) PET\u2013CT. The scan also guides the localization of a potential focal lesion along with perioperative frozen sections. Intraoperative decision-making is still challenging. This study aimed to describe the characteristics and potential clinical impact of intraoperative ultrasound imaging (IOUS) during CHI surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a prospective, observational study undertaken at an expert centre over a 2-year interval. IOUS was performed blinded to preoperative diagnostic test results (genetics and 18F-DOPA PET\u2013CT), followed by unblinding and continued IOUS during pancreatic resection. Characteristics and clinical impact were assessed using predefined criteria.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Eighteen consecutive, surgically treated patients with CHI, with a median age of 5.5 months, were included (focal 12, diffuse 3, atypical 3). Focal lesions presented as predominantly hypoechoic, oval lesions with demarcated or blurred margins. Patients with diffuse and atypical disease had varying echogenicity featuring stranding and non-shadowing hyperechoic foci in three of six, whereas these characteristics were absent from those with focal lesions. The blinded IOUS-based subclassification was correct in 17 of 18 patients; one diffuse lesion was misclassified as focal. IOUS had an impact on the surgical approach in most patients with focal lesions (9 of 12), and in those with diffuse (2 of 3) and atypical (2 of 3) disease when the resection site was close to the bile or pancreatic duct.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Uniform IOUS characteristics made all focal lesions identifiable. IOUS had a clinical impact in 13 of 18 patients by being a useful real-time supplementary modality in terms of localizing focal lesions, reducing the need for frozen sections, and preserving healthy tissue and delicate structures.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjsopen\/zraa008","type":"journal-article","created":{"date-parts":[[2021,3,10]],"date-time":"2021-03-10T13:16:30Z","timestamp":1615382190000},"source":"Crossref","is-referenced-by-count":6,"title":["Intraoperative ultrasound imaging in the surgical treatment of congenital hyperinsulinism: prospective, blinded study"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2199-7992","authenticated-orcid":false,"given":"A P","family":"Bjarnesen","sequence":"first","affiliation":[{"name":"Upper Gastrointestinal and Hepato-Pancreato-Biliary Section, Department of Surgery, Odense University Hospital , Odense, Denmark"},{"name":"Odense Pancreas Centre, OPAC, Odense University Hospital , Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Dahlin","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal and Hepato-Pancreato-Biliary Section, Department of Surgery, Odense University Hospital , Odense, Denmark"},{"name":"Odense Pancreas Centre, OPAC, Odense University Hospital , Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"Globa","sequence":"additional","affiliation":[{"name":"Ukrainian Research Centre of Endocrine Surgery, Endocrine Organs and Tissue Transplantation, Paediatric Endocrinology Department, Ministry of Health of Ukraine , Kiev, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1118-1500","authenticated-orcid":false,"given":"H","family":"Petersen","sequence":"additional","affiliation":[{"name":"PET and Cyclotron Unit, Department of Nuclear Medicine, Odense University Hospital , Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Brusgaard","sequence":"additional","affiliation":[{"name":"Department of Clinical Genetics, Odense University Hospital , Odense, Denmark"},{"name":"Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark , Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Rasmussen","sequence":"additional","affiliation":[{"name":"Odense Pancreas Centre, OPAC, Odense University Hospital , Odense, Denmark"},{"name":"Paediatric Surgery Section, Department of Surgery, Odense University Hospital , Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Melikian","sequence":"additional","affiliation":[{"name":"Endocrine Research Centre, Department of Paediatric Endocrinology , Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Detlefsen","sequence":"additional","affiliation":[{"name":"Odense Pancreas Centre, OPAC, Odense University Hospital , Odense, Denmark"},{"name":"Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark , Odense, Denmark"},{"name":"Department of Pathology, Odense University Hospital , Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7233-2344","authenticated-orcid":false,"given":"H T","family":"Christesen","sequence":"additional","affiliation":[{"name":"Odense Pancreas Centre, OPAC, Odense University Hospital , Odense, Denmark"},{"name":"Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark , Odense, Denmark"},{"name":"Hans Christian Andersen Children\u2019s Hospital, Odense University Hospital , Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M B","family":"Mortensen","sequence":"additional","affiliation":[{"name":"Upper Gastrointestinal and Hepato-Pancreato-Biliary Section, Department of Surgery, Odense University Hospital , Odense, Denmark"},{"name":"Odense Pancreas Centre, OPAC, Odense University Hospital , Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,11,11]]},"reference":[{"key":"2023020208421048500_zraa008-B1","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1297\/cpe.26.127","article-title":"Clinical practice guidelines for congenital hyperinsulinism","volume":"26","author":"Yorifuji","year":"2017","journal-title":"Clin Pediatr Endocrinol"},{"key":"2023020208421048500_zraa008-B2","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/1750-1172-6-63","article-title":"Congenital hyperinsulinism: current trends in diagnosis and therapy","volume":"6","author":"Arnoux","year":"2011","journal-title":"Orphanet J Rare Dis"},{"key":"2023020208421048500_zraa008-B3","doi-asserted-by":"crossref","first-page":"156","DOI":"10.3389\/fendo.2017.00156","article-title":"Both low blood glucose and insufficient treatment confer risk of neurodevelopmental impairment in congenital hyperinsulinism: a multinational cohort study","volume":"8","author":"Helleskov","year":"2017","journal-title":"Front Endocrinol"},{"key":"2023020208421048500_zraa008-B4","doi-asserted-by":"crossref","first-page":"57","DOI":"10.6065\/apem.2014.19.2.57","article-title":"Congenital hyperinsulinism: current status and future perspectives","volume":"19","author":"Yorifuji","year":"2014","journal-title":"Ann Pediatr Endocrinol Metab"},{"key":"2023020208421048500_zraa008-B5","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s13633-017-0048-8","article-title":"Diagnosis and treatment of hyperinsulinaemic hypoglycaemia and its implications for paediatric endocrinology","volume":"2017","author":"Demirbilek","year":"2017","journal-title":"Int J Pediatr Endocrinol"},{"key":"2023020208421048500_zraa008-B6","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1053\/j.sempedsurg.2010.10.010","article-title":"Morphologic analysis of focal and diffuse forms of congenital hyperinsulinism","volume":"20","author":"Rahier","year":"2011","journal-title":"Semin Pediatr Surg"},{"key":"2023020208421048500_zraa008-B7","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1159\/000323532","article-title":"Techniques in pediatric surgery: congenital hyperinsulinism","volume":"75","author":"Barthlen","year":"2011","journal-title":"Horm Res Paediatr"},{"key":"2023020208421048500_zraa008-B8","doi-asserted-by":"crossref","first-page":"e98054","DOI":"10.1371\/journal.pone.0098054","article-title":"Pancreatic endocrine and exocrine function in children following near-total pancreatectomy for diffuse congenital hyperinsulinism","volume":"9","author":"Arya","year":"2014","journal-title":"PLoS One"},{"key":"2023020208421048500_zraa008-B9","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/j.beem.2018.05.014","article-title":"Diagnosis and management of hyperinsulinaemic hypoglycaemia","volume":"32","author":"Galcheva","year":"2018","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"2023020208421048500_zraa008-B10","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1016\/j.jpedsurg.2012.11.025","article-title":"Accuracy of PET\/CT scan in the diagnosis of the focal form of congenital hyperinsulinism","volume":"48","author":"Laje","year":"2013","journal-title":"J Pediatr Surg"},{"key":"2023020208421048500_zraa008-B11","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.jpedsurg.2010.09.093","article-title":"The predictive value of preoperative fluorine-18-l-3,4-dihydroxyphenylalanine positron emission tomography\u2013computed tomography scans in children with congenital hyperinsulinism of infancy","volume":"46","author":"Zani","year":"2011","journal-title":"J Pediatr Surg"},{"key":"2023020208421048500_zraa008-B12","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1007\/s00259-017-3867-1","article-title":"18F-DOPA PET\/CT and 68Ga-DOTANOC PET\/CT scans as diagnostic tools in focal congenital hyperinsulinism: a blinded evaluation","volume":"45","author":"Christiansen","year":"2018","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"2023020208421048500_zraa008-B13","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1097\/01.pas.0000138000.61897.32","article-title":"Congenital hyperinsulinism: intraoperative biopsy interpretation can direct the extent of pancreatectomy","volume":"28","author":"Suchi","year":"2004","journal-title":"Am J Surg Pathol"},{"key":"2023020208421048500_zraa008-B14","doi-asserted-by":"crossref","first-page":"11","DOI":"10.3389\/fendo.2018.00478","article-title":"Intraoperative ultrasound: a tool to support tissue-sparing curative pancreatic resection in focal congenital hyperinsulinism","volume":"9","author":"Bendix","year":"2018","journal-title":"Front Endocrinol"},{"key":"2023020208421048500_zraa008-B15","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1055\/s-0029-1245598","article-title":"Intraoperative sonography: a technique for localizing focal forms of congenital hyperinsulinism in the pancreas","volume":"32","author":"von Rohden","year":"2011","journal-title":"Ultraschall Med"},{"key":"2023020208421048500_zraa008-B16","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1053\/j.sempedsurg.2010.10.011","article-title":"Visualization of the focus in congenital hyperinsulinism by intraoperative sonography","volume":"20","author":"von Rohden","year":"2011","journal-title":"Semin Pediatr Surg"},{"key":"2023020208421048500_zraa008-B17","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1016\/j.hpb.2018.04.003","article-title":"Systematic review and meta-analysis of postoperative pancreatic fistula rates using the updated 2016 International Study Group Pancreatic Fistula definition in patients undergoing pancreatic resection with soft and hard pancreatic texture","volume":"20","author":"Eshmuminov","year":"2018","journal-title":"HPB (Oxford)"},{"key":"2023020208421048500_zraa008-B18","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1111\/pedi.12989","article-title":"The difficult management of persistent, non-focal congenital hyperinsulinism: a retrospective review from a single, tertiary center","volume":"21","author":"Rasmussen","year":"2020","journal-title":"Pediatr Diabetes"},{"key":"2023020208421048500_zraa008-B19","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.jpedsurg.2018.10.030","article-title":"Surgical treatment of congenital hyperinsulinism: results from 500 pancreatectomies in neonates and children","volume":"54","author":"Adzick","year":"2019","journal-title":"J Pediatr Surg"},{"key":"2023020208421048500_zraa008-B20","first-page":"129","article-title":"Surgery in focal congenital hyperinsulinism (CHI)\u2014the \u2018Hyperinsulinism Germany International\u2019 experience in 30 children","volume":"14","author":"Barthlen","year":"2016","journal-title":"Pediatr Endocrinol Rev"},{"key":"2023020208421048500_zraa008-B21","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.gie.2006.12.043","article-title":"Histopathologic correlates of noncalcific chronic pancreatitis by EUS: a prospective tissue characterization study","volume":"66","author":"Varadarajulu","year":"2007","journal-title":"Gastrointest Endosc"},{"key":"2023020208421048500_zraa008-B22","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1016\/j.gie.2008.07.043","article-title":"EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification","volume":"69","author":"Catalano","year":"2009","journal-title":"Gastrointest Endosc"},{"key":"2023020208421048500_zraa008-B23","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1136\/jmedgenet-2015-103394","article-title":"Congenital hyperinsulinism in children with paternal 11p uniparental isodisomy and Beckwith\u2013Wiedemann syndrome","volume":"53","author":"Kalish","year":"2016","journal-title":"J Med Genet"},{"key":"2023020208421048500_zraa008-B24","doi-asserted-by":"crossref","first-page":"66","DOI":"10.3389\/fendo.2011.00066","article-title":"Paternal uniparental isodisomy of chromosome 11p15.5 within the pancreas causes isolated hyperinsulinemic hypoglycemia","volume":"2","author":"Flanagan","year":"2011","journal-title":"Front Endocrinol"}],"container-title":["BJS Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/5\/2\/zraa008\/49043708\/zraa008.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/5\/2\/zraa008\/49043708\/zraa008.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T08:58:42Z","timestamp":1675328322000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjsopen\/article\/doi\/10.1093\/bjsopen\/zraa008\/5973900"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,11]]},"references-count":24,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,3,5]]}},"URL":"https:\/\/doi.org\/10.1093\/bjsopen\/zraa008","relation":{},"ISSN":["2474-9842"],"issn-type":[{"value":"2474-9842","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,3]]},"published":{"date-parts":[[2020,11,11]]},"article-number":"zraa008"}}