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Portincasa P, Di Ciaula A, Bonfrate L, Stella A, Garruti G, Lamont JT. Metabolic dysfunction-associated gallstone disease: expecting more from critical care manifestations. Intern Emerg Med 2023; 18:1897-1918. [PMID: 37455265 PMCID: PMC10543156 DOI: 10.1007/s11739-023-03355-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
About 20% of adults worldwide have gallstones which are solid conglomerates in the biliary tree made of cholesterol monohydrate crystals, mucin, calcium bilirubinate, and protein aggregates. About 20% of gallstone patients will definitively develop gallstone disease, a condition which consists of gallstone-related symptoms and/or complications requiring medical therapy, endoscopic procedures, and/or cholecystectomy. Gallstones represent one of the most prevalent digestive disorders in Western countries and patients with gallstone disease are one of the largest categories admitted to European hospitals. About 80% of gallstones in Western countries are made of cholesterol due to disturbed cholesterol homeostasis which involves the liver, the gallbladder and the intestine on a genetic background. The incidence of cholesterol gallstones is dramatically increasing in parallel with the global epidemic of insulin resistance, type 2 diabetes, expansion of visceral adiposity, obesity, and metabolic syndrome. In this context, gallstones can be largely considered a metabolic dysfunction-associated gallstone disease, a condition prone to specific and systemic preventive measures. In this review we discuss the key pathogenic and clinical aspects of gallstones, as the main clinical consequences of metabolic dysfunction-associated disease.
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Affiliation(s)
- Piero Portincasa
- Clinica Medica "A. Murri", Division of Internal Medicine, Department of Preventive and Regenerative Medicine and Ionian Area (DiMePrev-J), University of Bari Aldo Moro, p.zza Giulio Cesare 11, 70124, Bari, Italy.
| | - Agostino Di Ciaula
- Clinica Medica "A. Murri", Division of Internal Medicine, Department of Preventive and Regenerative Medicine and Ionian Area (DiMePrev-J), University of Bari Aldo Moro, p.zza Giulio Cesare 11, 70124, Bari, Italy
| | - Leonilde Bonfrate
- Clinica Medica "A. Murri", Division of Internal Medicine, Department of Preventive and Regenerative Medicine and Ionian Area (DiMePrev-J), University of Bari Aldo Moro, p.zza Giulio Cesare 11, 70124, Bari, Italy
| | - Alessandro Stella
- Laboratory of Medical Genetics, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari, Italy
| | - Gabriella Garruti
- Section of Endocrinology, Department of Preventive and Regenerative Medicine and Ionian Area (DiMePrev-J), University of Bari Aldo Moro, Bari, Italy
| | - John Thomas Lamont
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02215, USA
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Grover AS, Gugig R, Barakat MT. Endoscopy and Pediatric Pancreatitis. Gastrointest Endosc Clin N Am 2023; 33:363-378. [PMID: 36948751 DOI: 10.1016/j.giec.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Children and adolescents are increasingly impacted by pancreatic disease. Interventional endoscopic procedures, including endoscopic retrograde cholangiopancreatography) and endoscopic ultrasonography, are integral to the diagnosis and management of many pancreatic diseases in the adult population. In the past decade, pediatric interventional endoscopic procedures have become more widely available, with invasive surgical procedures now being replaced by safer and less disruptive endoscopic interventions.
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Affiliation(s)
- Amit S Grover
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA 02115, USA
| | - Roberto Gugig
- Division of Pediatric Gastroenterology, Lucille Packard Children's Hospital at Stanford University Medical Center, Stanford, CA 94305, USA
| | - Monique T Barakat
- Division of Pediatric Gastroenterology, Lucille Packard Children's Hospital at Stanford University Medical Center, Stanford, CA 94305, USA; Division of Gastroenterology, Stanford University Medical Center, Stanford, CA 94305, USA.
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Chen X, He H, Chen X, Chen X, Wen Z, Xu M, Fang Y, He X. A Bibliometric Analysis of Publications on Endoscopic Ultrasound. Front Med (Lausanne) 2022; 9:869004. [PMID: 35425770 PMCID: PMC9002052 DOI: 10.3389/fmed.2022.869004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/07/2022] [Indexed: 01/04/2023] Open
Abstract
Background Over the past 40 years, endoscopic ultrasound (EUS) has become a safe and effective tool for both diagnostic and therapeutic applications. A growing number of articles have been published annually. We aimed to explore global scientific outputs and hotspots of EUS published by different countries, organizations, and authors. Methods The global literature regarding EUS during the 1900–2020 period was identified from the Web of Science (WOS) Core database. “Bibliometrix” and software VOSviewer were applied to perform bibliometric analysis. Results The annual growth rate of publications from 1980 to 2020 was around 16% and the number of EUS-related articles had experienced a sudden increase in the last decade. Bhutani MS was the most productive author over the past years, with 94 publications. Hawes RH had the highest number of citations, with 6,034 citations. The United States and institutions from United States dominated the EUS research. Among the journals, GASTROINTESTINAL ENDOSCOPY published the highest number of articles, followed by ENDOSCOPY. The majority of top 10 frequently cited references were cited more than 200 times. Carcinoma, diagnosis, fine-needle-aspiration, cytology, and pancreatitis were the important keywords in co-occurrence analysis of keywords. Recent studies focused more on tissue acquisition, size of the needle, lumen-apposing metal stent, and fine-needle- biopsy. Conclusion Research on EUS has significantly increased in the last decade globally and it will continue to increase. Active collaboration among different authors and countries was observed in the EUS field. Tissue acquisition, size of the needle, apposing metal stent, and fine-needle-biopsy might be the latest research frontiers and should receive more attention.
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Affiliation(s)
- Xiaoli Chen
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, China
| | - Huiqin He
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, China
| | - Xin Chen
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, China
| | - Xueqin Chen
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, China
| | - Zhenzhen Wen
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, China
| | - Mengque Xu
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, China
| | - Yanfei Fang
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, China
| | - Xingkang He
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, China
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4
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Hu J, Sun X, Ge N, Wang S, Guo J, Liu X, Wang G, Sun S. The necessarity of treatment for small gastric subepithelial tumors (1-2 cm) originating from muscularis propria: an analysis of 972 tumors. BMC Gastroenterol 2022; 22:182. [PMID: 35410177 PMCID: PMC9004094 DOI: 10.1186/s12876-022-02256-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 03/28/2022] [Indexed: 12/26/2022] Open
Abstract
Background and objectives Up till now, there are still controversies about the specific indication of endoscopic resection for small gastric subepithelial tumors (gSETs) originating from muscularis propria. We aimed to investigate the safety of endoscopic resection and postoperative pathology analysis.
Method The patients with primary small gSETs originating from muscularis propria, treated by endoscopic resection in the endoscopic center of Shengjing Hospital between January, 2011 and September, 2019 were enrolled. The complete resection rate, adverse events and clinicopathological features were recorded. Result A total of 936 patients with 972 gastric SETs ≤ 2 cm originating from muscularis propria were included in our study. All the lesions were successfully treated by endoscopic resection. Nearly half of lesions were proved to be gastrointestinal stromal tumor (GIST) [n = 411 (42.3%)] according to postoperative pathology. All the objects were further subdivided into 2 groups, ≤ 1 cm, > 1 and ≤ 2 cm gSETs. The risk of gastric GIST of intermediate/high risk in the group (> 1 and ≤ 2 cm gSETs) is 8.41 times as that of gastric GIST in the group (the size of gastric ≤ 1 cm gSETs) (P < 0.05). Conclusion Endoscopic resection is a safe and effective treatment for small gSETs. gSETs (1–2 cm) is more risky than gSETs (≤ 1 cm) and should be resected. This should be evaluated by further studies.
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Affiliation(s)
- Jinlong Hu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Xinzhu Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Nan Ge
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Sheng Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Jintao Guo
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Xiang Liu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Guoxin Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Siyu Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
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Kim SM, Kim EY, Cho JW, Jeon SW, Kim JH, Kim TH, Moon JS, Kim JO. Predictive Factors for Differentiating Gastrointestinal Stromal Tumors from Leiomyomas Based on Endoscopic Ultrasonography Findings in Patients with Gastric Subepithelial Tumors: A Multicenter Retrospective Study. Clin Endosc 2021; 54:872-880. [PMID: 34788936 PMCID: PMC8652168 DOI: 10.5946/ce.2021.251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/18/2021] [Indexed: 12/13/2022] Open
Abstract
Background/Aims The utility of endoscopic ultrasonography (EUS) for differentiating gastrointestinal stromal tumors (GISTs) and leiomyomas of the stomach is not well known. We aimed to evaluate the ability of EUS for differentiating gastric GISTs and leiomyomas.
Methods We retrospectively reviewed the medical records of patients with histopathologically proven GISTs (n=274) and leiomyomas (n=87). In two consensus meetings, the inter-observer variability in the EUS image analysis was reduced. Using logistic regression analyses, we selected predictive factors and constructed a predictive model and nomogram for differentiating GISTs from leiomyomas. A receiver operating characteristic (ROC) curve analysis was performed to measure the discrimination performance in the development and internal validation sets.
Results Multivariate analysis identified heterogeneity (odds ratio [OR], 9.48), non-cardia (OR, 19.11), and older age (OR, 1.06) as independent predictors of GISTs. The areas under the ROC curve of the predictive model using age, sex, and four EUS factors (homogeneity, location, anechoic spaces, and dimpling or ulcer) were 0.916 (sensitivity, 0.908; specificity, 0.793) and 0.904 (sensitivity, 0.908; specificity, 0.782) in the development and internal validation sets, respectively.
Conclusions The predictive model and nomogram using age, sex and homogeneity, tumor location, presence of anechoic spaces, and presence of dimpling or ulcer on EUS may facilitate differentiation between GISTs and leiomyomas.
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Affiliation(s)
- Sun Moon Kim
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Eun Young Kim
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Jin Woong Cho
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Seong Woo Jeon
- Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Ji Hyun Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Tae Hyeon Kim
- Department of Internal Medicine, Wonkwang University College of Medicine and Hospital, Iksan, Korea
| | - Jeong Seop Moon
- Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea
| | - Jin-Oh Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
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A rare cause of chronic dysphagia: pulmonary inflammatory myofibroblastic tumor with distal esophagus invasion. J Cardiothorac Surg 2021; 16:286. [PMID: 34627314 PMCID: PMC8501738 DOI: 10.1186/s13019-021-01662-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 09/19/2021] [Indexed: 02/08/2023] Open
Abstract
Background Inflammatory myofibroblastic tumor (IMT) is rare intermediate tumor, which happens mostly in children and young adults. Case presentation Reported is the successful treatment of a 29-year-old man presented with progressively dysphagia and weight loss. No other abnormal symptoms were observed. The contrast enhanced computed tomography (CT) revealed a dumbbell-shaped lesion between lung and esophagus. Finally, it was pathologically diagnosed as pulmonary IMT invading to the distal esophagus after operation. The patient underwent partial esophagectomy and left lower lobectomy, and was discharged on 10th postoperative day. Conclusions IMT is a rare lesion that usually occurs in the lung, but pulmonary IMT with distal esophagus invasion has not been described previously. Discriminating untypical symptom, completed resection, pathological expertise and closed follow-up will reach the successful diagnosis and treatment.
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Rare Benign Inflammatory Tumor of Esophagus Masquerading as Malignancy. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02307-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Zhong X, Xuan F, Qian Y, Pan J, Wang S, Chen W, Lin T, Zhu H, Wang X, Wang G. A genomic-clinicopathologic Nomogram for the preoperative prediction of lymph node metastasis in gastric cancer. BMC Cancer 2021; 21:455. [PMID: 33892676 PMCID: PMC8066490 DOI: 10.1186/s12885-021-08203-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 04/16/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Preoperative evaluation of lymph node (LN) state is of pivotal significance for informing therapeutic decisions in gastric cancer (GC) patients. However, there are no non-invasive methods that can be used to preoperatively identify such status. We aimed at developing a genomic biosignature based model to predict the possibility of LN metastasis in GC patients. METHODS We used the RNA profile retrieving strategy and performed RNA expression profiling in a large GC cohort (GSE62254, n = 300) from Gene Expression Ominus (GEO). In the exploratory stage, 300 GC patients from GSE62254 were involved and the differentially expressed RNAs (DERs) for LN-status were determined using the R software. GC samples in GSE62254 were randomly allocated into a learning set (n = 210) and a verification set (n = 90). By using the Least absolute shrinkage and selection operator (LASSO) regression approach, a set of 23-RNA signatures were established and the signature based nomogram was subsequently built for distinguishing LN condition. The diagnostic efficiency, as well as the clinical performance of this model were assessed using the decision curve analysis (DCA). Metascape was used for bioinformatic analysis of the DERs. RESULTS Based on the genomic signature, we established a nomogram that robustly distinguished LN status in the learning (AUC = 0.916, 95% CI 0.833-0.999) and verification sets (AUC = 0.775, 95% CI 0.647-0.903). DCA demonstrated the clinical value of this nomogram. Functional enrichment analysis of the DERs was performed using bioinformatics methods which revealed that these DERs were involved in several lymphangiogenesis-correlated cascades. CONCLUSIONS In this study, we present a genomic signature based nomogram that integrates the 23-RNA biosignature based scores and Lauren classification. This model can be utilized to estimate the probability of LN metastasis with good performance in GC. The functional analysis of the DERs reveals the prospective biogenesis of LN metastasis in GC.
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Affiliation(s)
- Xin Zhong
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, East Qingchun Road 3, Zhejiang, 310016, Hangzhou, China.
| | - Feichao Xuan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, East Qingchun Road 3, Zhejiang, 310016, Hangzhou, China
| | - Yun Qian
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, East Qingchun Road 3, Zhejiang, 310016, Hangzhou, China
| | - Junhai Pan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, East Qingchun Road 3, Zhejiang, 310016, Hangzhou, China
| | - Suihan Wang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, East Qingchun Road 3, Zhejiang, 310016, Hangzhou, China
| | - Wenchao Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, East Qingchun Road 3, Zhejiang, 310016, Hangzhou, China
| | - Tianyu Lin
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, East Qingchun Road 3, Zhejiang, 310016, Hangzhou, China
| | - Hepan Zhu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, East Qingchun Road 3, Zhejiang, 310016, Hangzhou, China
| | - Xianfa Wang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, East Qingchun Road 3, Zhejiang, 310016, Hangzhou, China.
| | - Guanyu Wang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, East Qingchun Road 3, Zhejiang, 310016, Hangzhou, China.
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Papanikolaou IS, Tziatzios G, Karatzas PS, Gkolfakis P, Facciorusso A, Triantafyllou K. Quality in pancreatic endoscopic ultrasound: what's new in 2020? Ann Gastroenterol 2020; 33:547-553. [PMID: 33162731 PMCID: PMC7599358 DOI: 10.20524/aog.2020.0537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022] Open
Abstract
Quality assessment and improvement of an endoscopic service has emerged as a basic component of everyday gastrointestinal endoscopy. In order to ensure a high level of quality, a series of actions must be adopted when performing an endoscopic examination. Nonetheless, quality still remains a qualitative parameter; thus, implementation of specific indicators of quality is warranted. Irrespective of the nature of the endoscopic procedure, quality indicators usually refer to either structural properties of an endoscopy unit (e.g., examination availability), procedural factors (e.g., diagnostic accuracy), or patient outcomes (e.g., occurrence of an adverse event related to performance of an endoscopic procedure). Moreover, they are usually classified into 3 distinct sections, according to the phase of the procedure they relate to: i.e., before, during, and after the examination. The aim of this review is to present measures that need to be adopted in order to reach an optimal quality level during an endoscopic ultrasound examination and to provide up-to-date data regarding the respective quality indicators implicated.
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Affiliation(s)
- Ioannis S Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Center, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece (Ioannis S. Papanikolaou, Georgios Tziatzios, Konstantinos Triantafyllou)
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Center, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece (Ioannis S. Papanikolaou, Georgios Tziatzios, Konstantinos Triantafyllou)
| | - Pantelis S Karatzas
- Academic Department of Gastroenterology and Hepatology, Laiko General Hospital, University of Athens, Medical School, Athens, Greece (Pantelis S. Karatzas)
| | - Paraskevas Gkolfakis
- Department of Gastroenterology Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium (Paraskevas Gkolfakis)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia AOU, Foggia, Italy (Antonio Facciorusso)
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Research Institute and Diabetes Center, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece (Ioannis S. Papanikolaou, Georgios Tziatzios, Konstantinos Triantafyllou)
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Posner H, Widmer J. EUS guided gallbladder drainage. Transl Gastroenterol Hepatol 2020; 5:41. [PMID: 32632392 DOI: 10.21037/tgh.2019.12.20] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/27/2019] [Indexed: 12/21/2022] Open
Abstract
Cholecystectomy is the gold standard treatment for acute cholecystitis, but it may not be appropriate for patients with significant comorbidities. Percutaneous gallbladder drainage (PT-GBD) and endoscopic transpapillary gallbladder drainage (ET-GBD) are alternatives with good technical and clinical success rates, but are limited by technical challenges and the need for definitive therapy. EUS-guided gallbladder drainage (EUS-GBD) is quickly becoming the preferred modality of treatment at expert centers in this cohort of patients due to increased efficacy and minimal adverse events. Technicalities of the procedure, including selection of access site, should be informed by the ultimate needs and anatomy of each patient. With the evolution of new stents and accessories, including a cautery-enhanced lumen apposing metal stent deployment system, success rates and adverse events are favorable. A review of published case series demonstrates an overall clinical success rate of approximately 97% for EUS-GBD. The most common complication is pneumoperitoneum, so the evolution of self-expanding LAMS is promising. EUS-GBD has been successfully described in cases where definitive therapy or a bridge to cholecystectomy is needed. As the procedure's applications continue to evolve, there should be greater discussion about specific details including access site and stent selection.
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Affiliation(s)
- Hannah Posner
- Division of Gastroenterology, Hepatology and Nutrition, New York University-Winthrop Hospital, Mineola, NY, USA
| | - Jessica Widmer
- Division of Gastroenterology, Hepatology and Nutrition, New York University-Winthrop Hospital, Mineola, NY, USA
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Ding H, Zhou P, Xu M, Chen W, Li Q, Chen T, Cai M, Chen T, Lian J, Zhang Y. Combining endoscopic ultrasound and tumor markers improves the diagnostic yield on the etiology of common bile duct dilation secondary to periampullary pathologies. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:314. [PMID: 31475184 DOI: 10.21037/atm.2019.06.51] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Unexplained common bile duct (CBD) dilatation may be caused by many etiologies, such as periampullary tumors, a pancreatic neoplasm, choledocholithiasis or an inflammatory stenosis. The aim of this study is to evaluate the diagnostic yield of endoscopic ultrasonography (EUS) in patients with unexplained CBD dilatation, in combination with tumor markers, liver chemistry, symptoms, surgical history and whether there is dilatation of the pancreatic duct (PD). Methods From January 2016 to July 2017, 115 patients were referred for EUS in our center for CBD dilatation of an unknown etiology. A treatment plan is made based on the EUS result combined with the other clinical information. The final diagnosis is determined by surgical histology or follow-up of at least 3 months. Results The sensitivity, specificity and accuracy of EUS for patients with choledocholithiasis were 100.0% (10/10), 100.0% (105/105) and 100.0% (115/115), respectively. The sensitivity, specificity and accuracy of EUS for patients with periampullary tumor were 86.5% (32/37), 89.7% (70/78) and 88.7% (102/115), respectively. The sensitivity, specificity and accuracy of EUS for patients with inflammatory stenosis were 88.2% (60/68), 89.4% (42/47) and 88.7% (102/115), respectively. The overall accuracy of EUS for diagnosing an undetermined etiology for CBD dilatation was 88.7% (102/115) and was higher than the accuracy of ultrasound (US) (64.1%), computed tomography (CT) (66.2%), magnetic resonance imaging (MRI) (67.0%) or PET-CT (66.0%). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EUS combined with tumor markers for patients with malignant dilatation of CBD were 91.9% (34/37), 97.4% (76/78), 94.4% (34/36), 96.2% (76/79) and 95.7% (110/115), respectively. PD dilation (P=0.026) and weight loss (P=0.035) had significant predictive values of malignancy. Conclusions EUS is an effective diagnostic tool for determining the etiology of a CBD dilatation, and offers meaningful information for guiding a treatment plan. EUS used in conjunction with tumor markers has high yield in differentiating benign and malignant CBD dilatation. More attention should be paid to patients with PD dilation or weight loss to prevent misdiagnosis of malignant CBD dilation.
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Affiliation(s)
- Han Ding
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Pinghong Zhou
- Endoscopy center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Meidong Xu
- Endoscopy center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Weifeng Chen
- Endoscopy center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Quanlin Li
- Endoscopy center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Tao Chen
- Endoscopy center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Mingyan Cai
- Endoscopy center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Tianyin Chen
- Endoscopy center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jingjing Lian
- Endoscopy center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yiqun Zhang
- Endoscopy center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Cho IR, Park JC, Roh YH, Choi SI, Lee JE, Kim EH, Shin SK, Lee SK, Lee YC. Noninvasive prediction model for diagnosing gastrointestinal stromal tumors using contrast-enhanced harmonic endoscopic ultrasound. Dig Liver Dis 2019; 51:985-992. [PMID: 30926282 DOI: 10.1016/j.dld.2019.02.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/22/2019] [Accepted: 02/25/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Subepithelial tumors (SETs) are difficult to diagnose accurately without invasive pathological confirmation. We created a noninvasive prediction model for diagnosing gastrointestinal stromal tumors (GISTs) using contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS). METHODS We retrospectively reviewed 176 patients who underwent CEH-EUS from October 2011 to August 2017. Seventy patients with a diagnosis of GIST (n = 37) or leiomyoma (n = 33) were included. The long-to-short axis ratio (LSR) and enhancement patterns (vascularity, diffuse enhancement) on CEH-EUS were assessed. Logistic regression and classification and regression tree (CART) analyses were performed. RESULTS The mean age of all patients was 54.9 ± 13.68 years. The GIST group showed significantly higher rates of positive vascularity (81.1% vs. 15.2%, p < 0.001) and diffuse enhancement (51.4% vs. 15.2%, p = 0.001), and lower LSR (1.30 vs. 1.76, p < 0.001). In multivariate logistic regression, positive vascularity (odds ratio [OR] 27.765, 95% confidence interval [CI] 5.336-144.458) and low LSR (OR 18.940, 95% CI 3.623-99.007) were independent predictors of GIST. A noninvasive prediction model for GISTs was developed using the CART model, by allocating patients according to statistically significant variables. CONCLUSIONS The LSR and vascularity of SETs on CEH-EUS can be used as parameters for a noninvasive prediction model of GISTs. This model may be helpful in the early identification and treatment of GISTs.
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Affiliation(s)
- In Rae Cho
- Department of Internal Medicine, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Jun Chul Park
- Department of Internal Medicine, Yonsei University College of Medicine, 03722, Seodaemun-gu, Seoul, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soo In Choi
- Department of Internal Medicine, Yonsei University College of Medicine, 03722, Seodaemun-gu, Seoul, Republic of Korea
| | - Jeung Eun Lee
- Department of Internal Medicine, Yonsei University College of Medicine, 03722, Seodaemun-gu, Seoul, Republic of Korea
| | - Eun Hye Kim
- Department of Internal Medicine, Yonsei University College of Medicine, 03722, Seodaemun-gu, Seoul, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Kwan Shin
- Department of Internal Medicine, Yonsei University College of Medicine, 03722, Seodaemun-gu, Seoul, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Kil Lee
- Department of Internal Medicine, Yonsei University College of Medicine, 03722, Seodaemun-gu, Seoul, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Chan Lee
- Department of Internal Medicine, Yonsei University College of Medicine, 03722, Seodaemun-gu, Seoul, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
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13
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Ang TL, Kwek ABE, Wang LM. Diagnostic Endoscopic Ultrasound: Technique, Current Status and Future Directions. Gut Liver 2019; 12:483-496. [PMID: 29291601 PMCID: PMC6143442 DOI: 10.5009/gnl17348] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/03/2017] [Accepted: 10/10/2017] [Indexed: 12/12/2022] Open
Abstract
Endoscopic ultrasound (EUS) is now well established as an important tool in clinical practice. From purely diagnostic imaging, it has progressed to include tissue acquisition, which provided the basis for therapeutic procedures. Even as interventional EUS developed, there has been ongoing progress in EUS diagnostic capabilities due to improved imaging systems, better needles for tissue acquisition and development of enhanced imaging functions such as contrast harmonic EUS (CHEUS) and EUS elastography. EUS is well established for differentiation of subepithelial lesions, for T-staging of luminal gastrointestinal and pancreaticobiliary malignancies, for differentiation of benign pancreaticobiliary disorders and for diagnostic tissue acquisition, which can be achieved by EUS-guided fine needle aspiration or by EUS-guided fine needle biopsy using dedicated biopsy needles. This review briefly describes the technique of performing EUS and then discusses its clinical utility in terms of gastrointestinal cancer staging, the evaluation of pancreaticobiliary disorders and tissue acquisition. Enhanced imaging techniques such as CHEUS and EUS elastography are briefly reviewed.
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Affiliation(s)
- Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Andrew Boon Eu Kwek
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Lai Mun Wang
- Section of Histopathology, Department of Laboratory Medicine, Changi General Hospital, Singapore
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14
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Ligresti D, Kuo YT, Baraldo S, Chavan R, Keane MG, Seleem S, Seo DW. EUS anatomy of the pancreatobiliary system in a swine model: The WISE experience. Endosc Ultrasound 2019; 8:249-254. [PMID: 31115384 PMCID: PMC6714482 DOI: 10.4103/eus.eus_10_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background and Objectives EUS training is recognized to have a substantial learning curve. To date, few dedicated training programs for EUS have been described. The swine model has been highlighted as a realistic tool to enhance EUS training. Studies extensively describing EUS swine anatomy are lacking in the current literature. The article aims to describe both radial and linear EUS pancreatobiliary swine anatomy. Materials and Methods Four live pigs were endoscoped under general anesthesia using both radial and linear array echoendoscopes. Relevant images and videos were recorded. Results It was possible to effectively image aorta, crus of the diaphragm, celiac trunk, superior mesenteric artery, pancreas, common bile duct, gallbladder, portal vein, kidneys, spleen, and hepatic hilum. Images were comparable to human EUS findings, with some remarkable differences. The pancreas was relatively larger in swine and in contrast to humans has three segments (duodenal, splenic, and connecting lobe). Conclusions The swine model was a highly realistic teaching model for linear and radial pancreatobiliary EUS and a useful tool for training in the setting of in vivo hands-on sessions.
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Affiliation(s)
- Dario Ligresti
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Specialized Advanced Therapies), Palermo, Italy
| | - Yu-Ting Kuo
- Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, National Taiwan University College of Medicine, Taipei, Taiwan, China
| | - Stefano Baraldo
- Department of Endoscopy, Barretos Cancer Hospital, Barretos, Brazil
| | - Radhika Chavan
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Margaret Geri Keane
- Department of Gastroenterology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shaimaa Seleem
- Department of Gastroenterology and Endoscopy, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Dong-Wan Seo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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15
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Portincasa P, Molina-Molina E, Garruti G, Wang DQH. Critical Care Aspects of Gallstone Disease. J Crit Care Med (Targu Mures) 2019; 5:6-18. [PMID: 30766918 PMCID: PMC6369569 DOI: 10.2478/jccm-2019-0003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/08/2019] [Indexed: 12/15/2022] Open
Abstract
Approximately twenty per cent of adults have gallstones making it one of the most prevalent gastrointestinal diseases in Western countries. About twenty per cent of gallstone patients requires medical, endoscopic, or surgical therapies such as cholecystectomy due to the onset of gallstone-related symptoms or gallstone-related complications. Thus, patients with symptomatic, uncomplicated or complicated gallstones, regardless of the type of stones, represent one of the largest patient categories admitted to European hospitals. This review deals with the important critical care aspects associated with a gallstone-related disease.
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Affiliation(s)
- Piero Portincasa
- Clinica Medica "A. Murri", Department of Biomedical Sciences & Human Oncology, University of Bari Medical School, Bari, Italy
- Piero Portincasa, Clinica Medica “Augusto Murri”, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School - Piazza Giulio Cesare 11; 70124 Bari – Italy
| | - Emilio Molina-Molina
- Clinica Medica "A. Murri", Department of Biomedical Sciences & Human Oncology, University of Bari Medical School, Bari, Italy
| | - Gabriella Garruti
- Section of Endocrinology, Department of Emergency and Organ Transplantations, University of Bari "Aldo Moro" Medical School, Piazza G. Cesare 11, 70124Bari, Italy
| | - David Q.-H. Wang
- Department of Medicine, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, "Albert Einstein" College of Medicine, Bronx, NY 10461, USA
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16
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Oría IC, Pizzala JE, Villaverde AM, Spina JC, Pasqua AV, Lazarte JC, Mazza OM, Marcolongo MM. Endoscopic Ultrasound in the Diagnosis of Pancreatoduodenal Groove Pathology: Report of Three Cases and Brief Review of the Literature. Clin Endosc 2018; 52:196-200. [PMID: 30408946 PMCID: PMC6453847 DOI: 10.5946/ce.2018.097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/31/2018] [Indexed: 12/15/2022] Open
Abstract
The pancreatoduodenal groove is a small area where pathologic processes involving the distal bile duct, duodenum, pancreatic head, ampulla of Vater, and retroperitoneum converge. Despite great advances in imaging techniques, a definitive preoperative diagnosis is challenging because of the complex anatomy of this area. Therefore, surgical intervention is frequently required because of the inability to completely exclude malignancy. We report 3 cases of patients with different groove pathologies but similar clinical and imaging presentation, and show the essential role of endoscopic ultrasound (EUS) in making a specific preoperative diagnosis, excluding malignancy in the first case, changing diagnosis in the second case, and confirming malignancy in the third case. EUS was a fundamental tool in this cohort of patients, not only because of its ability to provide superior visualization of a difficult anatomical region, but because of the ability to guide precise, real-time procedures, such as fine-needle aspiration.
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Affiliation(s)
- Inés C Oría
- Department of Gastroenterology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan E Pizzala
- Department of Gastroenterology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Augusto M Villaverde
- Department of Gastroenterology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan C Spina
- Department of Gastroenterology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Analía V Pasqua
- Department of Gastroenterology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Julio C Lazarte
- Department of Gastroenterology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Oscar M Mazza
- Department of Gastroenterology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mariano M Marcolongo
- Department of Gastroenterology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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17
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Facciorusso A, Buccino RV, Muscatiello N. How to measure quality in endoscopic ultrasound. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:266. [PMID: 30094252 DOI: 10.21037/atm.2018.03.36] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Quality is a key focus for gastrointestinal endoscopy and main international gastroenterology societies instituted specific task forces focused on this issue. Endoscopic ultrasound (EUS) represents one of the most fascinating fields to explore in gastrointestinal endoscopy due to its relatively limited availability out of high-volume centers. This leads to a particular need to define widely accepted quality indicators (QIs) and the ways to measure them. The current manuscript reviews these indicators in light of their impact on common clinical practice.
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Affiliation(s)
- Antonio Facciorusso
- Department of Medical Sciences, Gastroenterology Unit, University of Foggia, Foggia, Italy
| | | | - Nicola Muscatiello
- Department of Medical Sciences, Gastroenterology Unit, University of Foggia, Foggia, Italy
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18
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Keane MG, Kumar M, Cieplik N, Thorburn D, Johnson GJ, Webster GJ, Chapman MH, Lindley KJ, Pereira SP. Paediatric pancreaticobiliary endoscopy: a 21-year experience from a tertiary hepatobiliary centre and systematic literature review. BMC Pediatr 2018; 18:42. [PMID: 29426291 PMCID: PMC5807847 DOI: 10.1186/s12887-017-0959-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 12/08/2017] [Indexed: 12/21/2022] Open
Abstract
Background In adults ERCP and endoscopic ultrasound (EUS) are standard methods of evaluating and treating many hepatopancreaticobiliary (HPB) conditions. HPB disease is being diagnosed with increasing frequency in children but information about role of ERCP and EUS and their outcomes in this population remain limited. Therefore the aims of this study were to describe the paediatric ERCP and EUS experience from a large tertiary referral HPB centre, and to systematically compare outcomes with those of other published series. Methods All patients <18 years undergoing an ERCP or EUS between January 1992–December 2014 were included. Indications for the procedure, rates of technical success, procedural adverse events and reinterventions were recorded in all cases. Results Ninety children underwent 111 procedures (87 ERCPs and 24 EUS). 53% (48) were female with a median age of 14 years (range: 3 months - 17 years). Procedures were performed under general anaesthesia (n = 48) or conscious sedation (n = 63). Common indications for ERCP included chronic or recurrent pancreatitis and biliary obstruction. Patients frequently had multiple comorbidities, with a median ASA grade of 2 (range 1–4). Therapeutic procedures performed included biliary or pancreatic sphincterotomy, common bile duct or pancreatic duct stone removal, biliary or pancreatic stent insertion, EUS-guided fine needle aspiration and endoscopic transmural drainage of pancreatic fluid collections. No adverse events were reported following ERCP but there was one complication requiring surgery following EUS guided cystenterostomy. Conclusion ERCP and EUS in children and adolescents have high technical success rates and low rates of adverse events when performed in high volume HPB centres.
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Affiliation(s)
- Margaret G Keane
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, Pond St, London, NW3 2PF, UK
| | - Mayur Kumar
- Department of Gastroenterology, University College of London Hospital, 235 Euston Road, London, NW1 2BG, UK
| | - Natascha Cieplik
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, Pond St, London, NW3 2PF, UK
| | - Douglas Thorburn
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, Pond St, London, NW3 2PF, UK
| | - Gavin J Johnson
- Department of Gastroenterology, University College of London Hospital, 235 Euston Road, London, NW1 2BG, UK
| | - George J Webster
- Department of Gastroenterology, University College of London Hospital, 235 Euston Road, London, NW1 2BG, UK
| | - Michael H Chapman
- Department of Gastroenterology, University College of London Hospital, 235 Euston Road, London, NW1 2BG, UK
| | - Keith J Lindley
- Department of Gastroenterology, Great Ormond Street Hospital, London, WC1N 3JN, UK
| | - Stephen P Pereira
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, Pond St, London, NW3 2PF, UK.
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Jayarajah U, Bulathsinghala RP, Handagala DMS, Samarasekera DN. Inflammatory myofibroblastic tumor of the esophagus presenting with hematemesis and melaena: a case report and review of literature. Clin Case Rep 2018; 6:82-85. [PMID: 29375843 PMCID: PMC5771923 DOI: 10.1002/ccr3.1296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/04/2017] [Accepted: 10/27/2017] [Indexed: 11/12/2022] Open
Abstract
Esophageal inflammatory myofibroblastic tumors (IMT) are extremely rare, and the understanding on the clinical presentation is limited. IMT of esophagus should be considered as a differential diagnosis in the context of unexplained upper gastrointestinal bleeding and rapidly progressing dysphagia in young patients.
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Affiliation(s)
- Umesh Jayarajah
- Department of Surgery Faculty of Medicine University of Colombo Colombo Sri Lanka
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20
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Woo YS, Lee KH, Noh DH, Park JK, Lee KT, Lee JK, Jang KT. 22G versus 25G biopsy needles for EUS-guided tissue sampling of solid pancreatic masses: a randomized controlled study. Scand J Gastroenterol 2017; 52:1435-1441. [PMID: 28893106 DOI: 10.1080/00365521.2017.1322136] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND/OBJECTIVES No comparative study of 22-gauge biopsy needles (PC22) and 25-gauge biopsy needles (PC25) has been conducted. We prospectively compared the diagnostic accuracy of PC22 and PC25 in patients with pancreatic and peripancreatic solid masses. METHODS We conducted a randomized noninferiority clinical study from January 2013 to May 2014 at Samsung Medical Center. A cytological and histological specimen of each pass was analyzed separately by an experienced pathologist. The primary outcome was to assess the diagnostic accuracy using the PC22 or PC25. Secondary outcomes included the optimal number of passes for adequate diagnosis, core specimen yield, sample adequacy, and complication rates. RESULTS Diagnostic accuracy of combining cytology with histology in three cumulative passes was 97.1% (100/103) for the PC22 and 91.3% (94/103) for the PC25 group. Thus, noninferiority of PC25 to PC22 was not shown with a 10% noninferiority margin (difference, -5.8%; 95% CI, -12.1 to -0.5%). In a pairwise comparison with each needle type, two passes was non-inferior to three passes in the PC22 (96.1% vs. 97.1%; difference, -0.97%; 95% CI -6.63 to 4.69%) but noninferiority of two passes to three passes was not shown in the PC25 group (87.4% vs. 91.3%; difference, -3.88%; 95% CI, -13.5 to 5.7%). CONCLUSIONS Non-inferiority of PC25 to PC22 diagnostic accuracy was not observed for solid pancreatic or peripancreatic masses without on-site cytology. PC22 may be a more ideal device because only two PC22 needle passes was sufficient to establish an adequate diagnosis, whereas PC25 required three or more needle passes.
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Affiliation(s)
- Young Sik Woo
- a Department of Internal Medicine , Kangnam Sacred Heart Hospital, Hallym University College of Medicine , Seoul , Republic of Korea
| | - Kwang Hyuck Lee
- b Department of Medicine , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea.,c Department of Health Sciences and Technology , SAIHST, Sungkyunkwan University , Seoul , Republic of Korea
| | - Dong Hyo Noh
- d Department of Internal Medicine , Eulji University Hospital, Eulji University College of Medicine , Daejeon , Republic of Korea
| | - Joo Kyung Park
- b Department of Medicine , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
| | - Kyu Taek Lee
- b Department of Medicine , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
| | - Jong Kyun Lee
- b Department of Medicine , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
| | - Kee-Taek Jang
- e Department of Pathology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
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22
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Valero M, Robles-Medranda C. Endoscopic ultrasound in oncology: An update of clinical applications in the gastrointestinal tract. World J Gastrointest Endosc 2017; 9:243-254. [PMID: 28690767 PMCID: PMC5483416 DOI: 10.4253/wjge.v9.i6.243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/10/2017] [Accepted: 05/05/2017] [Indexed: 02/06/2023] Open
Abstract
An accurate staging is necessary to select the best treatment and evaluate prognosis in oncology. Staging usually begins with noninvasive imaging such as computed tomography, magnetic resonance imaging or positron emission tomography. In the absence of distant metastases, endoscopic ultrasound plays an important role in the diagnosis and staging of gastrointestinal tumors, being the most accurate modality for local-regional staging. Its use for tumor and nodal involvement in pre-surgical evaluation has proven to reduce unnecessary surgeries. The aim of this article is to review the current role of endoscopic ultrasound in the diagnosis and staging of esophageal, gastric and colorectal cancer.
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23
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Jiang X, Wang W, Yang Y, Du L, Yang X, Wang L, Zheng G, Duan W, Wang R, Zhang X, Wang L, Chen X, Wang C. Identification of circulating microRNA signatures as potential noninvasive biomarkers for prediction and prognosis of lymph node metastasis in gastric cancer. Oncotarget 2017; 8:65132-65142. [PMID: 29029418 PMCID: PMC5630318 DOI: 10.18632/oncotarget.17789] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/05/2017] [Indexed: 12/12/2022] Open
Abstract
Circulating microRNAs (miRNAs) are emerging as novel noninvasive biomarkers for prediction of lymph node metastasis (LNM) in cancer. The aim of this study was to identify serum miRNA signatures for prediction and prognosis of LNM in gastric cancer (GC). MiSeq sequencing was performed for an initial screening of serum miRNAs in 10 GC patients with LNM, 10 patients without LNM and 10 healthy controls. Reverse transcription quantitative real-time PCR was applied to confirm concentration of candidate miRNAs using a training cohort (n = 279) and a validation cohort (n = 180). We identified a four-miRNA panel (miR-501-3p, miR-143-3p, miR-451a, miR-146a) by multivariate logistic regression model that provided high predictive accuracy for LNM with an area under the receiver operating characteristic curve (AUC) of 0.891 (95% CI, 0.840 to 0.930) in training set. Prospective evaluation of this panel revealed an AUC of 0.822 (95% CI, 0.758 to 0.875, specificity = 87.78%, sensitivity = 63.33%) in validation set. Moreover, Kaplan-Meier analysis showed that LNM patients with low miR-451a and miR-146a levels had worse overall survival (OS) (p < 0.05). In Cox regression analysis, miR-451a was independently associated with OS of LNM (p = 0.028). Our results suggested that use of serum miRNAs seems promising in estimating the probability GC patients harbor LNM and providing prognostic information for LNM.
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Affiliation(s)
- Xiumei Jiang
- Department of Clinical Laboratory, The Second Hospital of Shandong University, Jinan, 250033, Shandong Province, China
| | - Wenfei Wang
- Humanistic Medicine Research Center, Shandong University, Jinan, 250012, Shandong Province, China
| | - Yongmei Yang
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, 250012, Shandong Province, China
| | - Lutao Du
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, 250012, Shandong Province, China
| | - Xiaoyun Yang
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, 250012, Shandong Province, China
| | - Lili Wang
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, 250012, Shandong Province, China
| | - Guixi Zheng
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, 250012, Shandong Province, China
| | - Weili Duan
- Department of Clinical Laboratory, The Second Hospital of Shandong University, Jinan, 250033, Shandong Province, China
| | - Rui Wang
- Department of Clinical Laboratory, The Second Hospital of Shandong University, Jinan, 250033, Shandong Province, China
| | - Xin Zhang
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, 250012, Shandong Province, China
| | - Lishui Wang
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, 250012, Shandong Province, China
| | - Xiaoyang Chen
- Humanistic Medicine Research Center, Shandong University, Jinan, 250012, Shandong Province, China
| | - Chuanxin Wang
- Department of Clinical Laboratory, The Second Hospital of Shandong University, Jinan, 250033, Shandong Province, China
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Specialized Imaging and Procedures in Pediatric Pancreatology: A North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Clinical Report. J Pediatr Gastroenterol Nutr 2017; 64:472-484. [PMID: 28230608 DOI: 10.1097/mpg.0000000000001371] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES An increasing number of children are being diagnosed with pancreatitis and other pancreatic abnormalities. Dissemination of the information regarding existing imaging techniques and endoscopic modalities to diagnose and manage pancreatic disorders in children is sorely needed. METHODS We conducted a review of the medical literature on the use of the following imaging and procedural modalities in pediatric pancreatology: transabdominal ultrasonography (TUS), computed tomography (CT), magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP). Recommendations for current use and future research were identified. RESULTS TUS offers noninvasive images of the pancreas but has limitations to details of parenchyma and ductal structures. CT offers improved detail of pancreatic parenchyma, solid masses, and traumatic injuries, but requires relatively high levels of ionizing radiation and does not adequately assess ductal anatomy. MRI/MRCP offers detailed intrinsic tissue assessment and pancreatic ductal characterization, but requires longer image acquisition time and is relatively poor at imaging calcifications. EUS provides excellent evaluation of pancreatic parenchyma and ductal anatomy, but can be subjective and operator dependent and requires sedation or anesthesia. EUS offers the capacity to obtain tissue samples and drain fluid collections and ERCP offers the ability to improve drainage by performing sphincterotomy or placing pancreatic stents across duct injuries and strictures. CONCLUSIONS Various imaging modalities may be used in pediatric pancreatology, but TUS and MRI/MRCP are favored. Interventional therapeutic maneuvers primarily involve use of ERCP and EUS. Future research is necessary to optimize equipment, expertise, and appropriate indications.
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Jeong SH, Yoon HH, Kim EJ, Kim YJ, Kim YS, Cho JH. High-resolution endoscopic ultrasound imaging and the number of needle passages are significant factors predicting high yield of endoscopic ultrasound-guided fine needle aspiration for pancreatic solid masses without an on-site cytopathologist. Medicine (Baltimore) 2017; 96:e5782. [PMID: 28079803 PMCID: PMC5266165 DOI: 10.1097/md.0000000000005782] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the accurate diagnostic method for pancreatic masses and its accuracy is affected by various FNA methods and EUS equipment. Therefore, we aimed to elucidate the instrumental and methodologic factors for determining the diagnostic yield of EUS-FNA for pancreatic solid masses without an on-site cytopathology evaluation.We retrospectively reviewed the medical records of 260 patients (265 pancreatic solid masses) who underwent EUS-FNA. We compared historical conventional EUS groups with high-resolution imaging devices and finally analyzed various factors affecting EUS-FNA accuracy.In total, 265 pancreatic solid masses of 260 patients were included in this study. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of EUS-FNA for pancreatic solid masses without on-site cytopathology evaluation were 83.4%, 81.8%, 100.0%, 100.0%, and 34.3%, respectively. In comparison with conventional image group, high-resolution image group showed the increased accuracy, sensitivity and specificity of EUS-FNA (71.3% vs 92.7%, 68.9% vs 91.9%, and 100% vs 100%, respectively). On the multivariate analysis with various instrumental and methodologic factors, high-resolution imaging (P = 0.040, odds ratio = 3.28) and 3 or more needle passes (P = 0.039, odds ratio = 2.41) were important factors affecting diagnostic yield of pancreatic solid masses.High-resolution imaging and 3 or more passes were the most significant factors influencing diagnostic yield of EUS-FNA in patients with pancreatic solid masses without an on-site cytopathologist.
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Affiliation(s)
- Seok Hoo Jeong
- Department of Internal Medicine, Catholic Kwandong University International St. Mary's Hospital
| | - Hyun Hwa Yoon
- Department of Internal Medicine, Gachon University School of Medicine, Gil Medical Center, Incheon, Korea
| | - Eui Joo Kim
- Department of Internal Medicine, Gachon University School of Medicine, Gil Medical Center, Incheon, Korea
| | - Yoon Jae Kim
- Department of Internal Medicine, Gachon University School of Medicine, Gil Medical Center, Incheon, Korea
| | - Yeon Suk Kim
- Department of Internal Medicine, Gachon University School of Medicine, Gil Medical Center, Incheon, Korea
| | - Jae Hee Cho
- Department of Internal Medicine, Gachon University School of Medicine, Gil Medical Center, Incheon, Korea
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The Clinical Utility of Evaluating the Luminal Upper Gastrointestinal Tract During Linear Endoscopic Ultrasonography. J Clin Gastroenterol 2016; 50:538-44. [PMID: 26501879 DOI: 10.1097/mcg.0000000000000434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The clinical utility of performing esophagogastroduodenoscopy (EGD) before linear endoscopic ultrasonography (L-EUS) to evaluate the luminal upper gastrointestinal (GI) tract is not well established. GOALS The study was aimed to determine the prevalence of clinically meaningful luminal abnormalities (any luminal finding requiring further evaluation with mucosal biopsy or initiation of treatment) in patients undergoing L-EUS. The study also sought to compare the ability of the gastroscope and the linear echoendoscope in identifying these lesions. STUDY A prospective, multicenter cohort study enrolled patients undergoing L-EUS for nonluminal indications. All patients underwent EGD followed by L-EUS by 2 different endoscopists. The second endoscopist was blinded to the results of the initial EGD. The identification of clinically meaningful luminal lesions and quality of endoscopic visualization of the upper GI tract were measured. RESULTS In the cohort of 175 patients, 52 (29.7%) patients had clinically meaningful luminal findings seen in the upper GI tract. There was no significant difference in the number of clinically meaningful lesions identified on EGD and L-EUS (25.1% vs. 22.9%, P=0.39). No significant difference was found in the miss rate of clinically meaningful lesions between the 2 modalities (EGD: 4.5% vs. EUS: 6.9%, P=0.39). CONCLUSIONS A substantial minority of patients undergoing L-EUS for nonluminal indications will have clinically meaningful luminal findings. The endoscopic evaluation of the luminal upper GI tract can be adequately achieved using the linear echoendoscope.
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Park SW, Chung MJ, Lee SH, Lee HS, Lee HJ, Park JY, Park SW, Song SY, Kim H, Chung JB, Bang S. Prospective Study for Comparison of Endoscopic Ultrasound-Guided Tissue Acquisition Using 25- and 22-Gauge Core Biopsy Needles in Solid Pancreatic Masses. PLoS One 2016; 11:e0154401. [PMID: 27149404 PMCID: PMC4858215 DOI: 10.1371/journal.pone.0154401] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 04/13/2016] [Indexed: 02/07/2023] Open
Abstract
Background and Aims Although thicker needles theoretically allow more tissue to be collected, their decreased flexibility can cause mechanical damage to the endoscope, technical failure, and sample blood contamination. The effects of needle gauge on diagnostic outcomes of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) of pancreatic mass lesions remain unknown. This study compared procurement rates of histologic cores obtained from EUS-FNB of pancreatic masses using 25- and 22-gauge core biopsy needles. Patients and Methods From March 2014 to July 2014, 66 patients with solid pancreatic mass underwent EUS-FNB with both 25- and 22-gauge core biopsy needles. Among them, 10 patients were excluded and thus 56 patients were eligible for the analyses. Needle sequences were randomly assigned, and two passes were made with each needle, consisting of 10 uniform to-and-fro movements on each pass with 10 mL syringe suction. A pathologist blinded to needle sequence evaluated specimens for the presence of histologic core. Results The mean patient age was 65.8 ± 9.5 years (range, 44–89 years); 35 patients (62.5%) were men. The mean pancreatic mass size was 35.3 ± 17.1 mm (range 14–122.3 mm). Twenty-eight patients (50%) had tumors at the pancreas head or uncinate process. There were no significant differences in procurement rates of histologic cores between 25-gauge (49/56, 87.5%) and 22-gauge (46/56, 82.1%, P = 0.581) needles or diagnostic accuracy using only histologic cores (98% and 95%). There were no technical failures or procedure-related adverse events. Conclusions The 25-gauge core biopsy needle could offer acceptable and comparable outcomes regarding diagnostic performance including histologic core procurement rates compared to the 22-gauge core biopsy needle, although the differences were not statistically significant. Trial Registration ClinicalTrials.gov NCT01795066
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Affiliation(s)
- Se Woo Park
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Korea
| | - Moon Jae Chung
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hoon Lee
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Seung Lee
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Jik Lee
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Yup Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Woo Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Si Young Song
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hoguen Kim
- Department of Pathology and Brain Korea 21 Projects for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Bock Chung
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seungmin Bang
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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Cho JW. Current Guidelines in the Management of Upper Gastrointestinal Subepithelial Tumors. Clin Endosc 2016; 49:235-40. [PMID: 26898512 PMCID: PMC4895944 DOI: 10.5946/ce.2015.096] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 10/10/2015] [Accepted: 12/22/2015] [Indexed: 12/13/2022] Open
Abstract
Subepithelial tumors are frequently found in asymptomatic patients in Japan and Korea where cancer screening tests routinely include endoscopy. Most lesions are asymptomatic and clinically insignificant. However, carcinoid tumors, lymphomas, glomus tumor and gastrointestinal stromal tumors (GISTs) are malignant or have the potential to become malignant. Inflammation due to parasitic infestation by Anisakis and poorly differentiated adenocarcinomas in the stomach rarely present as subepithelial lesions. In contrast to the frequency of gastric GIST in the gastrointestinal system, they are uncommon in the duodenum and very rare in the esophagus. The prognosis of patients with GISTs in the stomach is relatively good compared with GISTs in other organs. Along with the location of the tumor, its size and mitotic count are major factors that determine the malignant potential of GIST. Small (<2 cm) asymptomatic GISTs usually have benign clinical course. GIST is the most common subepithelial tumor to occur in the stomach. Although various methods are employed to diagnose GISTs, the risk of GIST metastasis cannot be accurately predicted before lesions are completely resected. Recently, new endoscopic diagnostic methods and treatment techniques have been developed that allow the diagnosis and resection of lesions located in the muscularis propria, without any complications. These endoscopic methods have different indications depending on regions where they are performed.
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Affiliation(s)
- Jin Woong Cho
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
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Affiliation(s)
- Eugene P DiMagno
- Mayo Medical School and Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA. .,, 630 Memorial Parkway SW, Rochester, MN, 55902, USA.
| | - Matthew J DiMagno
- University of Michigan School of Medicine and Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 1150 W Medical Center Drive, 6520 MSRB 1, Ann Arbor, MI, 48109, USA
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Eloubeidi MA, Decker GA, Chandrasekhara V, Chathadi KV, Early DS, Evans JA, Fanelli RD, Fisher DA, Foley K, Hwang JH, Jue TL, Lightdale JR, Pasha SF, Saltzman JR, Sharaf R, Shergill AK, Cash BD, DeWitt JM. The role of endoscopy in the evaluation and management of patients with solid pancreatic neoplasia. Gastrointest Endosc 2016; 83:17-28. [PMID: 26706297 DOI: 10.1016/j.gie.2015.09.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023]
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Portincasa P, Di Ciaula A, de Bari O, Garruti G, Palmieri VO, Wang DQH. Management of gallstones and its related complications. Expert Rev Gastroenterol Hepatol 2016; 10:93-112. [PMID: 26560258 DOI: 10.1586/17474124.2016.1109445] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The majority of gallstone patients remain asymptomatic; however, interest toward the gallstone disease is continuing because of the high worldwide prevalence and management costs and the development of gallstone symptoms and complications. For cholesterol gallstone disease, moreover, a strong link exists between this disease and highly prevalent metabolic disorders such as obesity, dyslipidemia, type 2 diabetes, hyperinsulinemia, hypertriglyceridemia and the metabolic syndrome. Information on the natural history as well as the diagnostic, surgical (mainly laparoscopic cholecystectomy) and medical tools available to facilitate adequate management of cholelithiasis and its complications are, therefore, crucial to prevent the negative outcomes of gallstone disease. Moreover, some risk factors for gallstone disease are modifiable and some preventive strategies have become necessary to reduce the onset and the severity of complications.
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Affiliation(s)
- P Portincasa
- a Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri" , University of Bari Medical School , Bari , Italy
| | - A Di Ciaula
- b Division of Internal Medicine , Hospital of Bisceglie , Bisceglie , Italy
| | - O de Bari
- a Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri" , University of Bari Medical School , Bari , Italy
- d Department of Internal Medicine, Division of Gastroenterology and Hepatology , Saint Louis University School of Medicine , St. Louis , MO , USA
| | - G Garruti
- c Department of Emergency and Organ Transplants, Section of Endocrinology, Andrology and Metabolic Diseases , University of Bari Medical School , Bari , Italy
| | - V O Palmieri
- a Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri" , University of Bari Medical School , Bari , Italy
| | - D Q-H Wang
- d Department of Internal Medicine, Division of Gastroenterology and Hepatology , Saint Louis University School of Medicine , St. Louis , MO , USA
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Khakural P, Sapkota R, Shrestha UK, Sayami P. Successful surgical management of a rare esophageal inflammatory myofibroblastic tumour: a case report. J Cardiothorac Surg 2015; 10:112. [PMID: 26353817 PMCID: PMC4564957 DOI: 10.1186/s13019-015-0327-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 09/04/2015] [Indexed: 01/22/2023] Open
Abstract
Inflammatory myofibroblastic tumour (IMT) is an uncommon mesenchymal tumour, which can occur anywhere in the body, rarely in esophagus. Mostly, the diagnosis is postoperative, after the hispathological evaluation of the specimen. There are no definite guidelines regarding the diagnosis and management. Here, we report a 60 year old lady presenting with dysphagia, diagnosed to have a submucosal esophageal tumor with Barium esophagogram and contrast enhanced computed tomography. She was managed successfully with surgical enucleation with the final histopathological diagnosis of IMT. Surgical excision is not only therapeutic but also diagnostic in such cases.
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Affiliation(s)
- Prabhat Khakural
- Department of CTVS, Manmohan Cardiothoracic Vascular and Transplant Centre, Kathmandu, Nepal.
| | - Ranjan Sapkota
- Department of CTVS, Manmohan Cardiothoracic Vascular and Transplant Centre, Kathmandu, Nepal.
| | - Uttam K Shrestha
- Department of CTVS, Manmohan Cardiothoracic Vascular and Transplant Centre, Kathmandu, Nepal.
| | - Prakash Sayami
- Department of CTVS, Manmohan Cardiothoracic Vascular and Transplant Centre, Kathmandu, Nepal.
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Son YJ, Lee MJ, Koh H, Kim S. Asymptomatic Bile Duct Dilatation in Children: Is It a Disease? Pediatr Gastroenterol Hepatol Nutr 2015; 18:180-6. [PMID: 26473138 PMCID: PMC4600702 DOI: 10.5223/pghn.2015.18.3.180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 08/23/2015] [Accepted: 09/02/2015] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Bile duct dilatation is a relatively common sonographic finding; nevertheless, its clinical significance in children is controversial because little research has been done in the area. Therefore, we investigated the natural course and clinical significance of biliary duct dilatation in children. METHODS We performed a retrospective study of 181 children (range, 1-day-old to 17-year-old) in whom dilatation of the intrahepatic duct and/or common hepatic duct and/or common bile duct was detected by abdominal ultrasonography at the Severance Children's Hospital between November 2005 and March 2014. We reviewed and analyzed laboratory test results, clinical manifestations, and clinical course in these patients. RESULTS Pediatric patients (n=181) were enrolled in the study and divided into two groups. The first group included 59 subjects, without definitive cause of bile duct dilatation, who did not require treatment; the second group included 122 subjects, with definitive cause of bile duct dilatation or underlying biliary disease, who did require treatment. In the first group, 24 patients (40.7%) showed spontaneous resolution of bile duct dilatation, 20 patients (33.9%) showed no change, and 15 patients (25.4%) were lost to follow-up. In the second group, 31 patients were diagnosed with choledochal cysts, and 91 patients presented with biliary tract dilatations due to secondary causes, such as gallbladder or liver disease, post-operative complications, or malignancy. CONCLUSION Biliary dilatation in pediatric patients without symptoms, and without laboratory and other sonographic abnormalities, showed a benign clinical course. No pathologic conditions were noted on follow-up ultrasonography.
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Affiliation(s)
- Yeo Ju Son
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Jung Lee
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Hong Koh
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
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Impact of endoscopic ultrasound-guided fine-needle aspiration and multidisciplinary approach in the management of abdominal or mediastinal mass. Eur J Gastroenterol Hepatol 2015; 27:1045-51. [PMID: 26011232 DOI: 10.1097/meg.0000000000000390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a useful tool for the diagnosis of suspected abdominal or mediastinal neoplastic lesions. AIM To evaluate the impact of EUS-FNA and multidisciplinary approach on the diagnostic work-up and therapeutic management of patients with abdominal or mediastinal neoplastic lesions. PATIENTS AND METHODS One hundred and twenty patients (69 men, median age 65 years) with a suspected abdominal or mediastinal neoplastic mass at computed tomography or MRI underwent EUS-FNA. All EUS-FNA findings and clinical data were evaluated by a multidisciplinary team (oncologists, surgeons, and gastroenterologists). EUS-FNA findings were compared with the final diagnosis made by histological evaluation of the surgical specimen or clinical outcome at follow-up. RESULTS A correct diagnosis was obtained by EUS-FNA in 96/120 patients (80%), indicating benignancy of the lesion in 21 (18%) cases and confirming malignancy in 75 (62%). On the basis of EUS-FNA findings, chemotherapy was tailored in 57/75 (76%) patients with malignancy whereas the surgical strategy was changed in 21/120 (18%) of patients. Overall, the diagnostic accuracy of EUS-FNA was 85%. A multidisciplinary team approach enabled a correct diagnosis in patients in whom EUS-FNA was nondiagnostic and to identify five cases with false-negative EUS-FNA findings. CONCLUSION EUS-FNA has a relevant impact on the management of suspected abdominal or mediastinal neoplastic lesions. A multidisciplinary team approach enables to overcome the EUS-FNA methodological limitations. The combination of EUS-FNA and multidisciplinary team approach could help to diagnose and tailor therapeutic options in such patients.
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Diagnostic and Therapeutic Roles of Endoscopic Ultrasound in Pediatric Pancreaticobiliary Disorders. J Pediatr Gastroenterol Nutr 2015; 61:238-47. [PMID: 25564818 DOI: 10.1097/mpg.0000000000000692] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The diagnostic role of endoscopic ultrasound (EUS) in children has only recently been demonstrated, and that also to a lesser extent than in adults. Data on the technique's therapeutic indications remain scarce. We therefore sought to evaluate diagnostic and interventional EUS indications, safety, and impact in children with pancreaticobiliary disorders. METHODS We retrospectively reviewed our single pediatric center records, covering a 14-year period. RESULTS From January 2000 to January 2014, 52 EUS procedures were performed in 48 children (mean age: 12 years; range: 2-17 years) with pancreaticobiliary disorders for the following indications: suspected biliary obstruction (n = 20/52), acute/chronic pancreatitis (n = 20), pancreatic mass (n = 3), pancreatic trauma (n = 7), and ampullary adenoma (n = 2). EUS was found to have a positive impact in 51 of 52 procedures, enabling us to avoid endoscopic retrograde cholangiopancreatography (ERCP) (n = 13 biliary; n = 6 pancreatic), focusing instead on endotherapy (n = 7 biliary; n = 14 pancreatic) or reorienting therapy toward surgery (n = 7). EUS-guided fine-needle aspiration was carried out on 12 patients for pancreatic tumor (n = 4), pancreatic cyst fluid analysis (n = 4), autoimmune pancreatitis (n = 2), and suspicion of biliary tumor (n = 2). A total of 13 therapeutic EUS procedures (11 children) were conducted, including 9 combined EUS-ERCP procedures (7 children, mean age: 8 years, range: 4-11 years), 3 EUS-guided pseudocyst drainage (2 children), and 1 EUS-guided transgastric biliary drainage. CONCLUSIONS Our study reports on a large pediatric EUS series for diagnostic and therapeutic pancreaticobiliary disorders, demonstrating the impact of diagnostic EUS and affording insights into novel EUS and combined EUS-ERCP therapeutic applications. We suggest considering EUS as a diagnostic and therapeutic tool in the management of pediatric pancreaticobiliary diseases.
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Ang TL, Kwek ABE, Seo DW, Paik WH, Cheng TY, Wang HP, Lau J. A prospective randomized study of the difference in diagnostic yield between endoscopic ultrasound-guided fine-needle aspiration (EUSFNA) needles with and without a side port in pancreatic masses. Endosc Int Open 2015; 3:E329-33. [PMID: 26356802 PMCID: PMC4554507 DOI: 10.1055/s-0034-1391964] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/04/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Two 22G needles with similar designs, apart from the absence (A) or presence of a side port (B), are available for endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA). The side port was designed to increase diagnostic yield but this advantage was unproven. This study evaluated the difference in diagnostic yield between both needles in pancreatic masses. PATIENTS AND METHODS This was a prospective multicenter randomized cross-over study. Patients with pancreatic masses were randomized to one needle for the first two passes, followed by the other for the next two passes. A pathologist blinded to the needle assessed each puncture for cellularity and morphology. The diagnostic yield between both needles was compared. RESULTS In total, 30 patients were recruited (mean lesion size: 3.5 cm, range: 1.2 - 6.3). Comparison of cellularity adequacy: first pass: A vs. B: 26/30 vs. 24/30 (P = 0.488): 2nd pass: A vs. B: 25/30 vs. 26/30 (P = 0.718). Comparison of diagnostic accuracy: first pass: A vs. B: 22/30 vs. 23/30 (P = 0.766); after two passes: A vs. B: 26/30 vs. 26/30 (P = 1.0). When all four passes were assessed, adequate cellularity was obtained in 29/30 and the correct diagnosis was obtained in 28/30 patients. There were no procedural complications. CONCLUSIONS There was no significant difference in diagnostic yield between EUSFNA needles with or without a side port for pancreatic masses. STUDY REGISTRATION NCT02092519.
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Affiliation(s)
- Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore,Corresponding author Tiing Leong Ang Department of Gastroenterology and HepatologyChangi General Hospital2 Simei Street 3Singapore 529889+65-67816202
| | - Andrew Boon Eu Kwek
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Dong Wan Seo
- Division of Gastroenterology, Asan Medical Centre, Seoul, Korea
| | - Woo Hyun Paik
- Division of Gastroenterology, Asan Medical Centre, Seoul, Korea
| | - Tsu-Yao Cheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - James Lau
- Department of Surgery, Chinese University of Hong Kong, Hong Kong, China
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Angelis CD, Marietti M, Bruno M, Pellicano R, Rizzetto M. Endoscopic ultrasound in common bile duct dilatation with normal liver enzymes. World J Gastrointest Endosc 2015; 7:799-805. [PMID: 26191344 PMCID: PMC4501970 DOI: 10.4253/wjge.v7.i8.799] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/23/2014] [Accepted: 05/27/2015] [Indexed: 02/05/2023] Open
Abstract
In recent years, the description of isolated bile duct dilatation has been increasingly observed in subjects with normal liver function tests and nonspecific abdominal symptoms, probably due to the widespread use of high-resolution imaging techniques. However, there is scant literature about the evolution of this condition and the impact of endoscopic ultrasound (EUS) in the diagnostic work up. When noninvasive imaging tests (transabdominal ultrasound, computed tomography or magnetic resonance cholangiopancreatography) fail to identify the cause of dilatation and clinical or biochemical alarm signs are absent, the probability of having biliary disease is considered low. In this setting, using EUS, the presence of pathologic findings (choledocholithiasis, strictures, chronic pancreatitis, ampullary or pancreatic tumors, cholangiocarcinoma), not always with a benign course, has been observed. The aim of this review has been to evaluate the prevalence of disease among non-jaundiced patients without signs of cytolysis and/or cholestasis and the assessment of EUS yield. Data point out to a promising role of EUS in the identification of a potential biliary pathology. EUS is a low invasive technique, with high accuracy, that could play a double cost-effective role: identifying pathologic conditions with dismal prognosis, in asymptomatic patients with negative prior imaging tests, and excluding pathologic conditions and further follow-up in healthy subjects.
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Jia Y, Maspons A, Othman MO. The therapeutic use of endoscopic ultrasonography in pediatric patients is safe: A case series. Saudi J Gastroenterol 2015; 21:391-5. [PMID: 26655135 PMCID: PMC4707808 DOI: 10.4103/1319-3767.167191] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND/AIM Despite the safety and high diagnostic yield of endoscopic ultrasound guided fine needle aspiration (EUS FNA) for the evaluation of gastrointestinal diseases in adults, literature discussing the therapeutic use of EUS FNA in pediatrics remains limited. This study reports our experience with the use of EUS in children with pancreaticobiliary disorders. PATIENTS AND METHODS A retrospective study was conducted to evaluate safety, clinical utility, and impact of therapeutic EUS on the management of children (<18 years) at a tertiary referral center. Data were collected from January 1, 2011, to April 30, 2014. Patient demographics, clinical characteristics, and EUS procedure data were reviewed. Continuous variables were described using the mean and standard deviation. Categorical variables were described using frequencies and percentages. RESULTS A total of 6 therapeutic EUS procedures were performed in 5 children (3 F/2 M). The mean age was 13 years (range 6-17) with a mean body mass index of 28.2 (range 18.5-38.8). The indications for EUS procedures were abdominal pain with chronic pancreatitis (3) and management of symptomatic pancreaticobiliary cysts/pseudocysts observed on previous imaging (3). All procedures were performed under general anesthesia. The 6 therapeutic procedures performed were celiac plexus block (3), cyst gastrostomy with stents placement (2), and cyst aspiration using EUS FNA (1). A celiac plexus block effectively relieved abdominal pain in 2 patients with chronic pancreatitis. Cyst gastrostomy successfully resulted in pseudocyst resolution in the follow up imaging of 2 patients (up to 6 months after the procedure). Cyst aspiration with EUS guided FNA resulted in cyst resolution and confirmation of the benign nature of the cyst in 1 patient. All the procedures were successfully completed with no reported complications. CONCLUSION The therapeutic use of endoscopic ultrasound in the pediatric population is safe and has a high success rate.
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Affiliation(s)
- Yi Jia
- Department of Gastroenterology, Texas Tech University Health Sciences Center, Texas, USA
| | - Aldo Maspons
- Department of Pediatrics, Texas Tech University Health Sciences Center, Texas, USA
| | - Mohammed O. Othman
- Department of Gastroenterology, Texas Tech University Health Sciences Center, Texas, USA,Address for correspondence: Dr. Mohammed O. Othman, Assistant Professor of Medicine - Gastroenterology Section, Baylor College of Medicine, 7200 Cambridge Street, Suite 10C, Houston, Texas - 77030, USA. E-mail:
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Unexplained common bile duct dilatation with normal serum liver enzymes: diagnostic yield of endoscopic ultrasound and follow-up of this condition. J Clin Gastroenterol 2014; 48:e67-70. [PMID: 24045275 DOI: 10.1097/mcg.0b013e3182a8848a] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is scant literature about common bile duct (CBD) dilatation with normal liver function tests (LFTs). AIMS The aims of this study were to assess the diagnostic yield of endoscopic ultrasound (EUS) in patients with CBD dilatation, normal LFTs, and prior inconclusive imaging tests, and to assess the natural history of these subjects. METHODS We retrospectively reviewed our EUS database for patients referred for evaluation of CBD dilatation, normal LFTs, and prior inconclusive imaging. We excluded patients with a prior endoscopic retrograde cholangiopancreatography or a history of biliary obstruction, pancreatitis, or jaundice. Follow-up data were retrieved from medical records or by calling the general practitioners, referring specialists, patients, or their closest relatives. RESULTS A total of 57 patients were enrolled. The mean CBD diameter was 12.5±3.6 mm. The majority of patients (50.8%) were asymptomatic. Abnormal EUS findings were recorded in 12 (21%) subjects: 6 patients had a periampullary diverticulum, 2 had ampullary adenoma, 2 had signs of chronic pancreatitis, 1 had a cancer of the pancreatic head, and 1 had a 7 mm CBD stone. Neither age, sex, prior cholecystectomy, clinical presentation, CBD diameter, nor a dilated main pancreatic duct were predictors of abnormal EUS findings. None of the patients complained of biliary symptoms or showed abnormal LFTs on long-term follow-up. CONCLUSIONS CBD dilatation with normal liver chemistry is not always a benign condition. Even when prior imaging tests are negative, EUS may allow to diagnose conditions overlooked by standard diagnostic imaging.
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Tarantino I, Di Mitri R, Fabbri C, Pagano N, Barresi L, Granata A, Liotta R, Mocciaro F, Maimone A, Baccarini P, Fabio T, Curcio G, Repici A, Traina M. Is diagnostic accuracy of fine needle aspiration on solid pancreatic lesions aspiration-related? A multicentre randomised trial. Dig Liver Dis 2014; 46:523-6. [PMID: 24704290 DOI: 10.1016/j.dld.2014.02.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 02/19/2014] [Accepted: 02/25/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic ultrasound fine needle aspiration has a central role in the diagnostic algorithm of solid pancreatic masses. Data comparing the fine needle aspiration performed with different aspiration volume and without aspiration are lacking. We compared endoscopic ultrasound fine needle aspiration performed with the 22 gauge needle with different aspiration volumes (10, 20 and 0 ml), for adequacy, diagnostic accuracy and complications. METHODS Prospective clinical study at four referral centres. Endoscopic ultrasound fine needle aspiration was performed with a 22G needle with both volume aspiration (10 and 20 cc) and without syringe, in randomly assigned sequence. The cyto-pathologist was blinded as to which aspiration was used for each specimen. RESULTS 100 patients met the inclusion criteria, 88 completed the study. The masses had a mean size of 32.21±11.24 mm. Sample adequacy evaluated on site was 87.5% with 20 ml aspiration vs. 76.1% with 10 ml (p=0.051), and 45.4% without aspiration (20 ml vs. 0 ml p<0.001; 10 ml vs. 0 ml p<0.001). The diagnostic accuracy was significantly better with 20 ml than with 10 ml and 0 ml (86.2% vs. 69.0% vs. 49.4% p<0.001). CONCLUSIONS A significantly higher adequacy and accuracy were observed with the 20 ml aspiration puncture, therefore performing all passes with this volume aspiration may improve the diagnostic power of fine needle aspiration.
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Affiliation(s)
- Ilaria Tarantino
- Gastroenterology Department, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Palermo, Italy.
| | - Roberto Di Mitri
- Gastroenterology Department, Civico-A.R.N.A.S. Hospital, Palermo, Italy
| | - Carlo Fabbri
- Gastroenterology Department, AUSL Bologna, Bellaria-Maggiore Hospital, Bologna, Italy
| | - Nico Pagano
- Gastroenterology Department, Humanitas Irccs, Rozzano, Milano, Italy
| | - Luca Barresi
- Gastroenterology Department, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Palermo, Italy
| | - Antonino Granata
- Gastroenterology Department, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Palermo, Italy
| | - Rosa Liotta
- Pathology Unit, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Italy
| | - Filippo Mocciaro
- Gastroenterology Department, Civico-A.R.N.A.S. Hospital, Palermo, Italy
| | | | - Paola Baccarini
- Pathology Unit, AUSL Bologna, Bellaria-Maggiore Hospital, Bologna, Italy
| | - Tuzzolino Fabio
- Office of Research, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Italy
| | - Gabriele Curcio
- Gastroenterology Department, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Palermo, Italy
| | - Alessandro Repici
- Gastroenterology Department, Humanitas Irccs, Rozzano, Milano, Italy
| | - Mario Traina
- Gastroenterology Department, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Palermo, Italy
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Prospective evaluation of adverse events following lower gastrointestinal tract EUS FNA. Am J Gastroenterol 2014; 109:676-85. [PMID: 24469614 DOI: 10.1038/ajg.2013.479] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/16/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES There are virtually no data concerning the risk of adverse events (AEs) following lower gastrointestinal (LGI) endoscopic ultrasound (EUS). Our aim was to determine the incidence and factors associated with AEs following LGI EUS fine needle aspiration (FNA). METHODS We conducted a prospective cohort study at a tertiary referral center. Five hundred and sixty-three patients underwent LGI EUS FNA between 1 January 2004 and 1 January 2012. We analyzed the 502 patients who had complete follow-up. AE severity was graded (1-5) utilizing Common Terminology Criteria or Visual Analog Scale. AEs were assessed during the procedures, in clinical follow-up, during phone interviews conducted at 7-14 days, and final clinical and/or phone interviews at 2-4 months. RESULTS AEs developed in 103 (20.5%) patients and were classified as grade 1, 2, 3, or 4 in 34 (6.8%), 41 (8.2%), 23 (4.6%), and 5 (1.0%) patients, respectively. Bleeding and pain were the commonest AEs. No deaths occurred. On multivariate analysis, AEs were associated with prior pain (odds ratio (OR): 3.83, 95% confidence interval (CI): 2.35-6.25), FNA from a site other than a lymph node (LN) or gut wall (OR: 2.26, 95% CI: 1.10-4.70), and malignant FNA cytology (OR: 1.80, 95% CI: 1.10-2.97); serious (grade 3-4) AEs were associated with prior pain (OR: 15.21, 95% CI: 5.04-45.85) and FNA from a site other than a LN or gut wall (OR: 3.25, 95% CI: 1.15-9.20). CONCLUSIONS LGI EUS FNA is associated with a high rate of serious grades 3-4 AEs. This may reflect the total number of associated interventions and the frequency of underlying pathology and symptoms.
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Cieslak KP, van Santvoort HC, Vleggaar FP, van Leeuwen MS, ten Kate FJ, Besselink MG, Molenaar IQ. The role of routine preoperative EUS when performed after contrast enhanced CT in the diagnostic work-up in patients suspected of pancreatic or periampullary cancer. Pancreatology 2014; 14:125-30. [PMID: 24650967 DOI: 10.1016/j.pan.2014.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 12/31/2013] [Accepted: 01/01/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND In patients suspected of pancreatic or periampullary cancer, abdominal contrast-enhanced computed tomography (CT) is the standard diagnostic modality. A supplementary endoscopic ultrasonography (EUS) is often performed, although there is only limited evidence of its additional diagnostic value. The aim of the study is to evaluate the additional diagnostic value of EUS over CT in deciding on exploratory laparotomy in patients suspected of pancreatic or periampullary cancer. METHODS We retrospectively analyzed 86 consecutive patients who routinely underwent CT and EUS before exploratory laparotomy with or without pancreatoduodenectomy for suspected pancreatic or periampullary carcinoma between 2007 and 2010. Primary outcomes were visibility of a mass, resectability on CT/EUS and resection with curative intent. RESULTS A mass was visible on CT in 72/86 (84%) patients. In these 72 patients, EUS demonstrated a mass in 64/72 (89%) patients. Resectability was accurately predicted by CT in 65/72 (90%) and by EUS in 58/72 (81%) patients. In 14/86 (16%) patients no mass was seen on CT. EUS showed a mass in 12/14 (86%) of these patients. A malignant lesion was histological proven in 11/12 (92%) of these patients. Overall, resectability was accurately predicted by CT and EUS in 90% (77/86) and 84% (72/86), respectively. CONCLUSIONS In patients with a visible mass on CT, suspected for pancreatic or periampullary cancer, EUS has no additional diagnostic value, does not influence the decision to perform laparotomy and should therefore not be performed routinely. In patients without a visible mass on CT, EUS is useful to confirm the presence of a tumor.
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Affiliation(s)
- Kasia P Cieslak
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
| | | | - Frank P Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands
| | | | - Fibo J ten Kate
- Department of Pathology, University Medical Center Utrecht, The Netherlands
| | - Marc G Besselink
- Department of Surgery, University Medical Center Utrecht, The Netherlands; Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - I Quintus Molenaar
- Department of Surgery, University Medical Center Utrecht, The Netherlands.
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Karadsheh Z, Al-Haddad M. Endoscopic ultrasound-guided fine-needle aspiration needles: which one and in what situation? Gastrointest Endosc Clin N Am 2014; 24:57-69. [PMID: 24215760 DOI: 10.1016/j.giec.2013.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is increasingly used as a diagnostic and therapeutic tool for pancreatic and other gastrointestinal disorders. Several factors affect the outcome of EUS-FNA, one of which is needle size. The decision to use a specific needle depends on factors including location, consistency, and type of the lesion; presence of onsite cytopathologist; and need for additional tissue procurement for histology. This review provides a balanced perspective on the use of different needle sizes available, highlighting the differences among them and potential niche applications of each to maximize diagnostic yield of EUS-FNA.
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Affiliation(s)
- Zeid Karadsheh
- Department of Internal Medicine, Brockton Hospital, 680 Centre Street, Brockton, MA 02302, USA
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Lachter J. Basic technique in endoscopic ultrasound-guided fine needle aspiration for solid lesions: What needle is the best? Endosc Ultrasound 2014; 3:46-53. [PMID: 24949410 PMCID: PMC4063259 DOI: 10.4103/2303-9027.124313] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 11/10/2013] [Indexed: 12/15/2022] Open
Abstract
Basic technique for endoscopic ultrasound (EUS) of solid lesions has developed during 30 years of EUS, as endoscopes and accessory equipment, particularly needles, have been developed. Systematic high-quality examinations require understanding and planning. Needles used for EUS-guided fine needle aspiration (FNA) have gone through many improvements; some 18 characteristics of any needle are presented and these come under consideration whenever choosing the best needle for each procedure. The bright future of EUS and FNA for solid lesions currently still leaves much room for continued developments.
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Affiliation(s)
- Jesse Lachter
- Department of Gastroenterology, Rambam Healthcare Campus EUS Service, Technion - Israel Institute of Technology, Faculty of Medicine, Haifa, Israel
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Kim SY, Jeon TY, Choi CI, Kim DH, Kim DH, Kim GH, Ryu DY, Lee BE, Kim HH. Validation of circulating miRNA biomarkers for predicting lymph node metastasis in gastric cancer. J Mol Diagn 2013; 15:661-9. [PMID: 23806809 DOI: 10.1016/j.jmoldx.2013.04.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 03/17/2013] [Accepted: 04/02/2013] [Indexed: 12/14/2022] Open
Abstract
We validated candidate biomarkers using circulating miRNAs by analyzing serum miRNA concentrations from patients with gastric cancer (GC) to predict lymph node (LN) metastasis. In a pilot study, serum levels of miR-21, miR-27a, miR-106b, miR-146a, miR-148a, miR-223, and miR-433 were compared in 10 healthy donors, 16 LN-positive patients with GC, and 15 LN-negative patients with GC. Then, we compared the level of three miRNAs (miR-21, miR-146a, and miR-148a) with the total of 79 GC patients with or without LN metastasis. In the pilot study, miR-21, miR-27a, miR-106b, miR-146a, miR-148a, and miR-223 concentrations from LN-positive patients with GC were significantly different from those of LN-negative patients with GC (P < 0.001, P = 0.003, P = 0.033, P < 0.001, P <0.001, and P = 0.017, respectively). In the validation study, levels of miR-21, miR-146a, and miR-148a increased as pN stage increased (P < 0.001, P = 0.001, and P < 0.001, respectively). Levels of the miRNAs were significantly different between pN0 and pN0 in the pT1 group (P = 0.013, P = 0.004, and P = 0.035, respectively) and among clinical stages (P = 0.001, P = 0.002, and P < 0.001, respectively). No differences in miRNA levels were observed by pT stage, Lauren's classification, sex, or age. Serum concentrations of miR-21, miR-146a, and miR-148a were closely associated with GC pN stage. These serum miRNA levels could be biomarker candidates to predict the presence of LN metastasis.
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Affiliation(s)
- Shine Young Kim
- Department of Clinical Laboratory Medicine, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea
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Fusaroli P, Caletti G. Endoscopic Ultrasound Staging of Gastric Lymphoma. VIDEO JOURNAL AND ENCYCLOPEDIA OF GI ENDOSCOPY 2013; 1:148-150. [DOI: 10.1016/s2212-0971(13)70061-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
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Lee JK, Choi JH, Lee KH, Kim KM, Shin JU, Lee JK, Lee KT, Jang KT. A prospective, comparative trial to optimize sampling techniques in EUS-guided FNA of solid pancreatic masses. Gastrointest Endosc 2013; 77:745-51. [PMID: 23433878 DOI: 10.1016/j.gie.2012.12.009] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 12/13/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is no standardization of the use of suction during puncturing of a target in pancreatic EUS-guided FNA (EUS-FNA). It is also debatable whether expressing aspirates from the needle by the traditional method of reinserting the stylet is more effective than by air flushing, which is easier and safer. OBJECTIVE To optimize sampling techniques in pancreatic EUS-FNA. DESIGN Prospective, comparative trial. SETTING Tertiary-care referral center. PATIENTS Eighty-one consecutive patients with solid pancreatic masses. INTERVENTION Four punctures were performed for each mass in random order by a 2 × 2 factorial design. Sample quality and diagnostic yield were compared between samples with suction (S+) versus no suction (S-) and expressed by reinserting the stylet (RS) versus air flushing (AF). MAIN OUTCOME MEASUREMENTS Sample quality by the number of diagnostic samples, cellularity, bloodiness, and air-drying artifact; diagnostic yield by accuracy, sensitivity, and specificity. RESULTS The number of diagnostic samples (72.8% vs 58.6%; P = .001), cellularity (odds ratio [OR] 2.12; 95% confidence interval [CI], 1.37-3.30; P < .001), bloodiness (OR 1.46; CI, 1.28-1.68; P < .001), accuracy (85.2% vs 75.9%; P = .004), and sensitivity (82.4% vs 72.1%; P = .005) were higher in S+ than in S-. Bloodiness was lower in AF than in RS (OR 1.16; CI, 1.03-1.30; P = .017). LIMITATIONS Single-center trial, 2 kinds of needle gauges, and no immediate cytopathology evaluation. CONCLUSION Puncturing with suction and expressing by air flushing may be used preferentially in pancreatic EUS-FNA because they were more effective and convenient techniques. ( CLINICAL TRIAL REGISTRATION NUMBER NCT01354795.).
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Affiliation(s)
- Jun Kyu Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Seoul, Republic of Korea
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Shetty D, Bhatnagar G, Sidhu HS, Fox BM, Dodds NI. The increasing role of endoscopic ultrasound (EUS) in the management of pancreatic and biliary disease. Clin Radiol 2013; 68:323-35. [PMID: 23391284 DOI: 10.1016/j.crad.2012.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 09/14/2012] [Accepted: 09/27/2012] [Indexed: 12/28/2022]
Abstract
Pancreatic and biliary disease continues to have a significant impact on the workload of the National Health Service (NHS), for which there exists a multimodality approach to investigation and diagnosis. Endoscopic ultrasound (EUS) is fast becoming a fundamental tool in this cohort of patients, not only because of its ability to provide superior visualization of a difficult anatomical region, but also because of its valuable role as a problem-solving tool and ever-improving ability in an interventional capacity. We provide a comprehensive review of the benefits of EUS in everyday clinical practice.
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Affiliation(s)
- D Shetty
- Department of Clinical Radiology, Royal Cornwall Hospital, Truro, Cornwall, UK
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Anderson MA, Appalaneni V, Ben-Menachem T, Decker GA, Early DS, Evans JA, Fanelli RD, Fisher DA, Fisher LR, Fukami N, Hwang JH, Ikenberry SO, Jain R, Jue TL, Khan K, Krinsky ML, Malpas PM, Maple JT, Sharaf RN, Shergill AK, Dominitz JA, Cash BD. The role of endoscopy in the evaluation and treatment of patients with biliary neoplasia. Gastrointest Endosc 2013; 77:167-74. [PMID: 23219047 DOI: 10.1016/j.gie.2012.09.029] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 09/20/2012] [Indexed: 02/08/2023]
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50
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Conwell DL, Wu BU. Chronic pancreatitis: making the diagnosis. Clin Gastroenterol Hepatol 2012; 10:1088-95. [PMID: 22642958 DOI: 10.1016/j.cgh.2012.05.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2010] [Revised: 04/21/2012] [Accepted: 05/20/2012] [Indexed: 02/07/2023]
Affiliation(s)
- Darwin L Conwell
- Center for Pancreatic Disease, Brigham and Women's Hospital, Division of Gastroenterology, Hepatology and Endoscopy, Harvard Medical School, Boston, MA, USA.
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