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Profit DD. Describing and Predicting Preprocedural Anxiety in Patients Scheduled for Advanced Gastrointestinal Endoscopy During the COVID-19 Pandemic. Gastroenterol Nurs 2023; 46:475-488. [PMID: 37639614 DOI: 10.1097/sga.0000000000000766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/26/2023] [Indexed: 08/31/2023] Open
Abstract
Advanced gastrointestinal endoscopy includes a group of specialized procedures and interventions that are being performed more frequently, with little attention given to a patient's preprocedural anxiety issues. Compounding this concern, in 2020 the COVID-19 pandemic resulted in the delay of many endoscopy cases. It is unknown how this affected the anxiety of patients preparing for advanced endoscopy procedures. Patients with higher anxiety require higher doses of anesthetic medications, and experience increased pain and decreased satisfaction. The purpose of this study was to describe the biological, psychological, and social attributes of patients and identify whether social support, COVID-19-related anxiety, delay of procedure, patient's physical status, and procedural indication category were predictors of state anxiety levels in patients undergoing advanced gastrointestinal endoscopy during the COVID-19 pandemic. The research study was a cross-sectional descriptive design with 90 patients. Patients were classified into low state and high state anxiety groups. Fifty-eight percent of patients had high state anxiety scores. Using logistic regression, social support was identified as a predictor of preprocedural anxiety (odds ratio [OR] = 0.318 [95% confidence interval, CI = 0.170, 0.597, p < .001]) as less social support was associated with higher anxiety. It is imperative that strategies to maximize social support are reinforced.
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Affiliation(s)
- Dawn Donahue Profit
- Dawn Donahue Profit, PhD, RN, is Staff Development Specialist, Nursing Staff Development, UK HealthCare, Lexington, Kentucky
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2
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Vitali F, Zundler S, Jesper D, Wildner D, Strobel D, Frulloni L, Neurath MF. Diagnostic Endoscopic Ultrasound in Pancreatology: Focus on Normal Variants and Pancreatic Masses. Visc Med 2023; 39:121-130. [PMID: 37899794 PMCID: PMC10601528 DOI: 10.1159/000533432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/03/2023] [Indexed: 10/31/2023] Open
Abstract
Background Endoscopic ultrasound (EUS) is a main tool in gastroenterology for both diagnosis and exclusion of pancreatic pathology. It allows minimally invasive assessment of various diseases or anatomic variations affecting the pancreas also with the help of new Doppler technologies, elastography, contrast-enhanced imaging including post hoc image processing with quantification analyses, three-dimensional reconstruction, and artificial intelligence. EUS also allows interventional direct access to the pancreatic parenchyma and the retroperitoneal space, to the pancreatic duct, pancreatic masses, cysts, and vascular structures. Summary This review aimed to summarize new developments of EUS in the field of pancreatology. We highlight the role of EUS in evaluating pancreatic pathology by describing normal anatomic variants like pancreas divisum, pancreatic lipomatosis, pancreatic fibrosis in the elderly and characterizing pancreatic masses, both in the context of chronic pancreatitis and within healthy pancreatic parenchyma. EUS is considered the optimal imaging modality for pancreatic masses of uncertain dignity and allows both cytological diagnosis and histology, which is essential not only for neoplastic conditions but also for tailoring therapy for benign inflammatory conditions. Key Messages EUS plays an indispensable role in pancreatology and the development of new diagnostic and interventional approaches to the retroperitoneal space and the pancreas exponentially increased over the last years. The development of computer-aided diagnosis and artificial intelligence algorithms hold the potential to overcome the obstacles associated with interobserver variability and will most likely support decision-making in the management of pancreatic disease.
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Affiliation(s)
- Francesco Vitali
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian Zundler
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Daniel Jesper
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Dane Wildner
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Deike Strobel
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Luca Frulloni
- Department of Medicine, Gastroenterology Unit, Pancreas Center, University of Verona, Verona, Italy
| | - Markus F. Neurath
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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3
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Optimal criteria for predicting lymph node metastasis in esophageal squamous cell carcinoma by anatomical location using preoperative computed tomography: a retrospective cohort study. Surg Today 2022; 52:1185-1193. [PMID: 35122521 DOI: 10.1007/s00595-022-02460-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/17/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Predicting lymph node metastasis (LNM) in esophageal squamous cell carcinoma (ESCC) is critical for selecting appropriate treatments despite the low accuracy of computed tomography (CT) for detecting LNM. Variation in potential nodal sizes among locations or patients' clinicopathological background factors may impact the diagnostic quality. This study explored the optimal criteria and diagnostic ability of CT by location. METHODS We retrospectively reviewed preoperative CT scans of 229 patients undergoing curative esophagectomy. We classified nodal stations into six groups: Cervical (C), Right-upper mediastinal (UR), Left-upper mediastinal (UL), Middle mediastinal (M), Lower mediastinal (L), and Abdominal (A). We then measured the short-axial diameter (SAD) of the largest lymph node in each area. We used receiver operating characteristics analyses to evaluate the CT diagnostic ability and determined the cut-off values for the SAD in all groups. RESULTS Optimal cut-offs were 6.5 mm (M), 6 mm (C, L, and A), and 5 mm (UR and UL). Diagnostic abilities differed among locations, and UR had the highest sensitivity. A multivariate analysis showed poor differentiation to be an independent risk factor for a false-negative diagnosis (p = 0.044). CONCLUSIONS Optimal criteria and diagnostic abilities for predicting LNM in ESCC varied among locations, and poor differentiation might contribute to failure to detect LNM.
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Takahashi K, Ohyama H, Mikata R, Nagashima H, Ohno I, Takiguchi Y, Kato N. Intraperitoneal bleeding from the right gastroepiploic artery by endoscopic ultrasonography: a case report. J Rural Med 2022; 17:184-188. [PMID: 35847751 PMCID: PMC9263947 DOI: 10.2185/jrm.2022-002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/29/2022] [Indexed: 11/27/2022] Open
Abstract
Objective: To describe the case of a patient with intraperitoneal bleeding
from the gastroepiploic artery by endoscopic ultrasound who was successfully treated with
transcatheter arterial coil embolization. Patient and Methods: An 87-year-old man was referred to our hospital for
examination of a gallbladder tumor. Endoscopic ultrasonography was performed using an
oblique-view echoendoscope. After the endoscopic ultrasound, the patient went into shock.
Computed tomography revealed a huge intraperitoneal hematoma and an aneurysm in the right
gastroepiploic artery that were not seen on previous computed tomography images. Thus,
urgent catheter angiography was performed, which showed a pseudoaneurysm of the right
gastroepiploic artery and extravasation of the contrast medium from the
pseudoaneurysm. Results: Transcatheter arterial coil embolization was subsequently
performed, and the bleeding stopped. Thereafter, his hemodynamics stabilized and his
general condition improved. The patient was discharged 22 days post-treatment with an
uneventful course. Conclusion: Observation-only endoscopic ultrasound without invasive
procedures can cause intraperitoneal bleeding due to a ruptured splanchnic artery. Thus,
endoscopic ultrasonography should be performed more carefully in elderly patients.
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Affiliation(s)
- Koji Takahashi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
| | - Hiroshi Ohyama
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
| | - Rintaro Mikata
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
| | - Hiroki Nagashima
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
| | - Izumi Ohno
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
| | - Yuichi Takiguchi
- Department of Medical Oncology, Graduate School of Medicine, Chiba University, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
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5
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Forbes N, Coelho-Prabhu N, Al-Haddad MA, Kwon RS, Amateau SK, Buxbaum JL, Calderwood AH, Elhanafi SE, Fujii-Lau LL, Kohli DR, Pawa S, Storm AC, Thosani NC, Qumseya BJ. Adverse events associated with EUS and EUS-guided procedures. Gastrointest Endosc 2022; 95:16-26.e2. [PMID: 34711402 DOI: 10.1016/j.gie.2021.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 02/07/2023]
Affiliation(s)
| | - Nauzer Forbes
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | - Richard S Kwon
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Stuart K Amateau
- Division of Gastroenterology, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - James L Buxbaum
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Audrey H Calderwood
- Section of Gastroenterology and Hepatology, Department of Medicine, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Sherif E Elhanafi
- Department of Internal Medicine, Texas Tech University, Paul L Foster School of Medicine, El Paso, TX, USA
| | | | - Divyanshoo R Kohli
- Division of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO, USA
| | - Swati Pawa
- Department of Medicine, Section on Gastroenterology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Andrew C Storm
- Department of Gastroenterology, Mayo Clinic, Rochester, MN, USA
| | - Nirav C Thosani
- Center for Interventional Gastroenterology (iGUT), McGovern Medical School, UTHealth, Houston, TX, USA
| | - Bashar J Qumseya
- Department of Gastroenterology, University of Florida, Gainesville, FL, USA
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6
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Kamran U, King D, Dosanjh A, Coupland B, Leeds J, Nayar M, Patel P, Trudgill N, Oppong KW. Pancreaticobiliary endoscopic ultrasound in England 2007 to 2016: Changing practice and outcomes. Endosc Int Open 2021; 9:E1731-E1739. [PMID: 34790537 PMCID: PMC8589557 DOI: 10.1055/a-1534-2558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022] Open
Abstract
Background and study aims Population-level data on the outcomes of pancreaticobiliary endoscopic ultrasound (PB-EUS) are limited. We examined national PB-EUS and fine-needle aspiration (FNA) activity, its relation to pancreatic cancer therapy, associated mortality and adverse events. Patients and methods Adults undergoing PB-EUS in England from 2007-2016 were identified in Hospital Episode Statistics. A pancreatic cancer cohort diagnosed within 6 months of PB-EUS were studied separately. Multivariable logistic regression models examined associations with 30-day mortality and therapies for pancreatic cancer. Results 79,269 PB-EUS in 68,908 subjects were identified. Annual numbers increased from 2,874 (28 % FNA) to 12,752 (35 % FNA) from 2007 to 2016. 8,840 subjects (13 %) were diagnosed with pancreatic cancer. Sedation related adverse events were coded in 0.5 % and emergency admission with acute pancreatitis in 0.2 % within 48 hours of PB-EUS. 1.5 % of subjects died within 30 days of PB-EUS. Factors associated with 30-day mortality included increasing age (odds ratio 1.03 [95 % CI 1.03-1.04]); male sex (1.38 [1.24-1.56]); increasing comorbidity (1.49 [1.27-1.74]); EUS-FNA (2.26 [1.98-2.57]); pancreatic cancer (1.39 [1.19-1.62]); increasing deprivation (least deprived quintile 0.76 [0.62-0.93]) and lower provider PB-EUS volume (2.83 [2.15-3.73]). Factors associated with surgical resection in the pancreatic cancer cohort included lower provider PB-EUS volume (0.44 [0.26-0.74]) and the least deprived subjects (1.33 [1.12-1.57]). 33 % of pancreatic cancer subjects who underwent EUS, did not subsequently receive active cancer treatment. Conclusions Lower provider PB-EUS volume was associated with higher 30-day mortality and reduced rates of both pancreatic cancer surgery and chemotherapy. These results suggest potential issues with case selection in lower-volume EUS providers.
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Affiliation(s)
- Umair Kamran
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom
| | - Dominic King
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom
| | - Amandeep Dosanjh
- Health Informatics, University Hospitals Birmingham NHS Foundation Trust, United Kingdom
| | - Ben Coupland
- Health Informatics, University Hospitals Birmingham NHS Foundation Trust, United Kingdom
| | - John Leeds
- HPB Unit and Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom,Population Health Sciences Institute, Newcastle University, United Kingdom
| | - Manu Nayar
- HPB Unit and Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
| | - Prashant Patel
- Health Informatics, University Hospitals Birmingham NHS Foundation Trust, United Kingdom
| | - Nigel Trudgill
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom
| | - Kofi W. Oppong
- HPB Unit and Department of Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom,Institute of Translational and Clinical Research, Newcastle University, United Kingdom
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Kanno A, Yasuda I, Irisawa A, Hara K, Ashida R, Iwashita T, Takenaka M, Katanuma A, Takikawa T, Kubota K, Kato H, Nakai Y, Ryozawa S, Kitano M, Isayama H, Kamada H, Okabe Y, Hanada K, Ohtsubo K, Doi S, Hisai H, Shibukawa G, Imazu H, Masamune A. Adverse events of endoscopic ultrasound-guided fine-needle aspiration for histologic diagnosis in Japanese tertiary centers: Multicenter retrospective study. Dig Endosc 2021; 33:1146-1157. [PMID: 33284491 DOI: 10.1111/den.13912] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is used for the histopathological diagnosis of any type of gastrointestinal disease. Few adverse events are experienced with this procedure; however, the actual rate of adverse events remains unclear. This study aimed to clarify the current status of cases that experienced adverse events related to the EUS-FNA procedure used for histopathologic diagnoses. METHODS A retrospective analysis of cases with EUS-FNA-related adverse events in Japanese tertiary centers was conducted by assessing the following clinical data: basic case information, FNA technique, type of procedural adverse events, and prognosis. RESULTS Of the 13,566 EUS-FNA cases overall, the total number of cases in which adverse events related to EUS-FNA occurred was 234. The incidence of EUS-FNA-related adverse events was ~1.7%. Bleeding and pancreatitis cases accounted for ~49.1% and 26.5% of all adverse events, respectively. Bleeding was the most common adverse event with only seven cases requiring blood transfusion. In cases with neuroendocrine tumors, pancreatitis was the most frequent adverse event. Needle tract seeding because of EUS-FNA was observed during the follow-up period in only ~0.1% of cases with pancreatic cancer. There was no mortality because of adverse events caused by EUS-FNA. CONCLUSIONS This study revealed that the adverse events-related EUS-FNA for histopathologic diagnoses were not severe conditions, and had low incidence.
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Affiliation(s)
- Atsushi Kanno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan.,Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Reiko Ashida
- Departments of Cancer Survey and Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.,Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Tetsuya Takikawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kensuke Kubota
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Kanagawa, Japan
| | - Hironari Kato
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Hideki Kamada
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yoshinobu Okabe
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Keiji Hanada
- Department of Gastroenterology, JA Onomichi General Hospital, Hiroshima, Japan
| | - Koushiro Ohtsubo
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Ishikawa, Japan
| | - Shinpei Doi
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Hiroyuki Hisai
- Department of Gastroenterology, Japanese Red Cross Date Hospital, Hokkaido, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Hiroo Imazu
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
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Apadula L, Capurso G, Arcidiacono PG. Patient-reported experience measure in pancreatobiliary endoscopy: a systematic review to highlight areas for improvement. Eur J Gastroenterol Hepatol 2021; 33:832-838. [PMID: 33136730 DOI: 10.1097/meg.0000000000001957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Increasing attention is paid to measure patient's experience using specific patient-reported experience measures (PREMs) as tool to assess the overall quality of care provided. The European Society of Gastrointestinal Endoscopy and the United European Gastroenterology have recognized the measure of quality of endoscopy facilities as a priority to provide an adequate service. However, although some studies included patient satisfaction measurement, specific PREMs for gastrointestinal endoscopy are limited, especially in the field of pancreatobiliary endoscopy, with heterogeneous methods and results. This study is aimed at systematically reviewing the literature to summarize the available PREMs for pancreatobiliary endoscopy and to highlight areas of implementation. METHODS PubMed, Embase and Scopus were searched until February 2020. RESULTS The search initially retrieved 1064 articles, but only six were includable. The identified studies employed several methods to measure patient's experience, with the most frequently used questionnaires being Gastrointestinal Endoscopy Satisfaction Questionnaire and Group Health Association of America-9. The following areas that need implementation were identified: (a) evaluation of pain is one of the most investigated areas but seems marginal, as most pancreatobiliary endoscopic procedures are performed under deep sedation; (b) endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography are considered as a whole, but they have very different indication and contexts (e.g. inpatients or outpatients); (c) 'experience' and 'satisfaction' are wrongly considered as synonyms; (d) the optimal modality and timing of questionnaire administration are unclear. CONCLUSION There are few tools to measure PREMS in pancreatobiliary endoscopy with several limitations. We have, therefore, started the process of building a specific PREM tool for pancreatobiliary EUS.
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Affiliation(s)
- Laura Apadula
- Pancreatobiliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
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9
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Zhang M, Zhu C, Wang Y, Kong Z, Hua Y, Zhang W, Si X, Ye B, Xu X, Li L, Heng D, Liu B, Tian S, Wu J, Dang Y, Zhang G. Differential diagnosis for esophageal protruded lesions using a deep convolution neural network in endoscopic images. Gastrointest Endosc 2021; 93:1261-1272.e2. [PMID: 33065026 DOI: 10.1016/j.gie.2020.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/01/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Recent advances in deep convolutional neural networks (CNNs) have led to remarkable results in digestive endoscopy. In this study, we aimed to develop CNN-based models for the differential diagnosis of benign esophageal protruded lesions using endoscopic images acquired during real clinical settings. METHODS We retrospectively reviewed the images from 1217 patients who underwent white-light endoscopy (WLE) and EUS between January 2015 and April 2020. Three deep CNN models were developed to accomplish the following tasks: (1) identification of esophageal benign lesions from healthy controls using WLE images; (2) differentiation of 3 subtypes of esophageal protruded lesions (including esophageal leiomyoma [EL], esophageal cyst (EC], and esophageal papilloma [EP]) using WLE images; and (3) discrimination between EL and EC using EUS images. Six endoscopists blinded to the patients' clinical status were enrolled to interpret all images independently. Their diagnostic performances were evaluated and compared with the CNN models using the area under the receiver operating characteristic curve (AUC). RESULTS For task 1, the CNN model achieved an AUC of 0.751 (95% confidence interval [CI], 0.652-0.850) in identifying benign esophageal lesions. For task 2, the proposed model using WLE images for differentiation of esophageal protruded lesions achieved an AUC of 0.907 (95% CI, 0.835-0.979), 0.897 (95% CI, 0.841-0.953), and 0.868 (95% CI, 0.769-0.968) for EP, EL, and EC, respectively. The CNN model achieved equivalent or higher identification accuracy for EL and EC compared with skilled endoscopists. In the task of discriminating EL from EC (task 3), the proposed CNN model had AUC values of 0.739 (EL, 95% CI, 0.600-0.878) and 0.724 (EC, 95% CI, 0.567-0.881), which outperformed seniors and novices. Attempts to combine the CNN and endoscopist predictions led to significantly improved diagnostic accuracy compared with endoscopists interpretations alone. CONCLUSIONS Our team established CNN-based methodologies to recognize benign esophageal protruded lesions using routinely obtained WLE and EUS images. Preliminary results combining the results from the models and the endoscopists underscored the potential of ensemble models for improved differentiation of lesions in real endoscopic settings.
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Affiliation(s)
- Min Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chang Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yun Wang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zihao Kong
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yifei Hua
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weifeng Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xinmin Si
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bixing Ye
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaobing Xu
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lurong Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ding Heng
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | | | | | | | - Yini Dang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guoxin Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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10
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Bjerring OS, Hess S, Petersen H, Fristrup CW, Lundell L, Mortensen MB. Value of regular endosonography and [18F]fluorodeoxyglucose PET-CT after surgery for gastro-oesophageal junction, stomach or pancreatic cancer. BJS Open 2020; 5:6044702. [PMID: 33688946 PMCID: PMC7944502 DOI: 10.1093/bjsopen/zraa028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/28/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Most patients undergo follow-up after surgery for cancers of the gastro-oesophageal junction, stomach or pancreas, but data to support which modalities to use and the frequency of investigation are limited. METHODS Patients in the EUFURO study were randomized to either visits to the outpatient clinic at 3, 6, 9, 12, 18, and 24 months after surgery (standard), or to the addition of [18F]fluorodeoxyglucose (FDG) PET-CT and endoscopic ultrasonography (EUS) with guided fine-needle aspiration biopsy to clinical assessments (intervention). Data from the intervention arm were used to analyse the diagnostic performance of endosonography or [18F]FDG PET-CT in detecting recurrences. RESULTS During the scheduled follow-up, 42 of 89 patients developed recurrence; PET-CT and EUS in combination detected 38 of these recurrences. EUS detected 23 of the 42 patients with recurrent disease during follow-up and correctly diagnosed 17 of 19 locoregional recurrences. EUS was able to detect isolated locoregional recurrence in 11 of 13 patients. In five patients, EUS was false-positive for isolated locoregional recurrence owing to missed distant metastases. PET-CT detected locoregional recurrence in only 12 of 19 patients, and isolated locoregional recurrence in only 7 of 13. False-positive PET-CT results in 23 patients led to a total of 44 futile procedures. CONCLUSION Accuracy in detecting recurrences by concomitant use of PET-CT and EUS was high (90 per cent). PET-CT had moderate to high sensitivity for overall recurrence detection, but low specificity. EUS was superior to PET-CT in the detection of locoregional and isolated locoregional recurrences.
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Affiliation(s)
- O S Bjerring
- Department of Surgery, Odense University Hospital, Odense, Denmark.,OPAC, Odense Pancreas Centre, Odense University Hospital, Odense, Denmark
| | - S Hess
- Department of Physiology and Nuclear Medicine, Odense University Hospital, Odense, Denmark.,Department of Radiology and Nuclear Medicine, Hospital South West Jutland, Esbjerg, Denmark.,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - H Petersen
- Department of Physiology and Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - C W Fristrup
- Department of Surgery, Odense University Hospital, Odense, Denmark.,OPAC, Odense Pancreas Centre, Odense University Hospital, Odense, Denmark
| | - L Lundell
- Department of Surgery, Odense University Hospital, Odense, Denmark.,CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - M B Mortensen
- Department of Surgery, Odense University Hospital, Odense, Denmark.,OPAC, Odense Pancreas Centre, Odense University Hospital, Odense, Denmark
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11
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Mizuide M, Ryozawa S, Fujita A, Ogawa T, Katsuda H, Suzuki M, Noguchi T, Tanisaka Y. Complications of Endoscopic Ultrasound-Guided Fine Needle Aspiration: A Narrative Review. Diagnostics (Basel) 2020; 10:diagnostics10110964. [PMID: 33213103 PMCID: PMC7698484 DOI: 10.3390/diagnostics10110964] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/05/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023] Open
Abstract
Considerable progress has been made recently in the use of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) to diagnose intra-luminal gastrointestinal lesions and extra-luminal lesions near the gastrointestinal tract. Numerous reports have indicated that EUS-FNA has high diagnostic performance and safety, which has led to the routine use of EUS-FNA and an increasing number of cases. Thus, while EUS-FNA has a low rate of complications, endoscopists may encounter these complications as the number of cases increases. Infrequent reports have also described life-threatening complications. Therefore, endoscopists should possess a comprehensive understanding of the complications of EUS-FNA, which include hemorrhage, perforation, infection, and acute pancreatitis, as well as their management. This review examines the available evidence regarding the complications associated with EUS-FNA, and the findings will be useful for ensuring that endoscopists perform EUS-FNA safely and appropriately.
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Affiliation(s)
| | - Shomei Ryozawa
- Correspondence: ; Tel.: +81-42-984-4111; Fax: +81-42-984-0432
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12
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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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13
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Guo J, Wang Z, Qin J, Zhang H, Liu W, Zhao Y, Lu Y, Yan X, Zhang Z, Zhang T, Zhang S, Dominik NM, Kamel IR, Li H, Qu J. A prospective analysis of the diagnostic accuracy of 3 T MRI, CT and endoscopic ultrasound for preoperative T staging of potentially resectable esophageal cancer. Cancer Imaging 2020; 20:64. [PMID: 32912319 PMCID: PMC7488416 DOI: 10.1186/s40644-020-00343-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/02/2020] [Indexed: 12/28/2022] Open
Abstract
Background Patients with esophageal cancer (EC) undergo endoscopic ultrasound and CT based cancer staging. Recent technical developments allow improved MRI quality with diminished motion artifact that may allow MRI to compare favorable to CT for noninvasive staging. Hence the purpose of the study was to assess image quality and diagnostic accuracy of 3 T MRI versus CT and EUS for preoperative T-staging of potentially resectable esophageal cancer. Methods Between October-2014 and December-2017, esophageal cancer patients with T-staging by EUS were enrolled in this prospective study. Post-operative histopathologic T-staging was the reference standard. All participants underwent MRI [T2- multi-shot turbo spin echo sequence (msTSE), diffusion-weighted imaging (DWI), and 3D gradient-echo based sequence (3D-GRE)] and CT [non-contrast and multiphase contrast-enhanced CT scanning] 5.6 + 3.6 days after endoscopy. Surgery was performed within 3.6 + 3.5 days after imaging. Two blinded endoscopists (reader 1 and 2) and radiologists (reader 3 and 4) independently evaluated EUS and CT/MRI, respectively. Considering the clinical relevance, patients were dichotomized into early (T1 and T2) vs late (T3 and T4) stage cancer before assessment. For statistical purpose, the binary decision was defined as the ability of the imaging technique to diagnose early stage/not early stage esophageal cancer. Diagnostic performance of EUS, MRI and CT was compared using McNemar’s test with Bonferroni correction; kappa values were assessed for reader performance. Results 74 study participants (60 ± 8 yrs.; 56 men) with esophageal cancer were evaluated, of whom 85%(63/74) had squamous cell carcinoma, 61%(45/74) were at early stage and 39%(29/74) were at late stage cancer, as determined by histopathology. Intra- and Inter-reader agreement for pre-operative vs post-operative T-staging was excellent for all imaging modalities. Compared to CT, MRI showed significantly higher accuracy for both the readers (reader3: 96% vs 82%, p = 0.0038, reader4: 95% vs 80%, p = 0.0076, for MRI vs CT, respectively). Further, MRI outperformed EUS with higher specificity (reader 1 vs 3: 59% vs 93%, p = 0.0015, reader 2 vs 4: 66% vs 93%, p = 0.0081, for EUS vs MRI respectively), and accuracy (reader 1 vs 3: 81% vs 96%, p = 0.0022, reader 2 vs 4: 85% vs 95%, p = 0.057, for EUS vs MRI, respectively). Conclusion For resectable esophageal cancer, MRI had better diagnostic performance for tumor staging compared to CT and EUS. Trial registration ChiCTR, ChiCTR-DOD, Registered 2nd October 2014, http://www.chictr.org.cn/showproj.aspx?proj=9620
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Affiliation(s)
- Jia Guo
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Zhaoqi Wang
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Jianjun Qin
- Department of Thoracic surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Hongkai Zhang
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Wentao Liu
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Yan Zhao
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Yanan Lu
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Xu Yan
- NEA MR Collaboration, Siemens Ltd.,China, Shanghai, 201318, China
| | - Zhongxian Zhang
- Department of Pathology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Ting Zhang
- Department of Pathology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Shouning Zhang
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, China
| | | | - Ihab R Kamel
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205-2196, USA
| | - Hailiang Li
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Jinrong Qu
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, China.
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14
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Music and pain during endorectal ultrasonography examination: A prospective questionnaire study and literature review. Radiography (Lond) 2020; 26:e164-e169. [DOI: 10.1016/j.radi.2020.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/21/2019] [Accepted: 01/13/2020] [Indexed: 01/22/2023]
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15
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Marchetti G, Ricardo VD, Ardengh AO, de Almeida AF, Taglieri E, Micelli-Neto O, Kemp R, Dos Santos JS, Ardengh JC. Adverse events and mortality: comparative analysis between diagnostic and interventional endoscopic ultrasound. Scand J Gastroenterol 2020; 55:995-1001. [PMID: 32663052 DOI: 10.1080/00365521.2020.1792975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Escalating an indication of EUS for diagnosis and treatment justifies the evaluation of the conditions associated with the adverse events (AE) and related deaths. The aim is to evaluate and compare the incidence of AE and deaths after diagnostic-EUS (D-EUS) and interventional-EUS (I-EUS). METHODS This retrospective study included patients undergoing D-EUS and I-EUS, in two centers for 28 years (03/1992 to 12/2019). Were noted parameters such as: age, gender, indication of EUS, modality, time of occurrence and severity of AE, type of treatment imposed and whether there was death. Descriptive analysis was performed using means, standard deviation and frequencies of the variables of interest. RESULTS 13,196 procedures performed, 9843 D-EUS and 3353 I-EUS. Thirty-seven (0.3%) had AE with six deaths (0.04%). The overall rate of AE for D-EUS and I-EUS was 0.08% and 0.86%, respectively (p > .05). Three deaths (0.03%) occurred after D-EUS and three (0.09%) after I-EUS. AE were immediate and early in 70% and 30%, respectively, with no late complications. Perforation was detected immediately in 80% and early in 20%, being more frequent after D-EUS than I-EUS. Acute pancreatitis occurred immediately in 70% and early in 30%. The AE were mild, moderate, and severe in 35.1%, 27%, and 37.8%, respectively. Overall, D-EUS presented the majority of AE as severe (87.5%), while I-EUS presented mild AE in most cases (41.4%), followed by severe complications (24.1%). CONCLUSIONS Despite the low incidence of AE and mortality after EUS, the occurrence of severe complications, especially perforation in D-EUS, may support the review of therapeutic protocols, aiming to ensure that a quality and safety process is implemented in the practice of EUS.
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Affiliation(s)
| | | | | | | | - Eloy Taglieri
- Endoscopy Department, Hospital 9 de Julho, São Paulo, Brazil
| | | | - Rafael Kemp
- Digestive Endoscopy Section, Department of Surgery and Anatomy, Clinical Hospital of Ribeirão Preto Medical School, University of São Paulo (HCFMRP-USP), São Paulo, Brazil
| | - José Sebastião Dos Santos
- Digestive Endoscopy Section, Department of Surgery and Anatomy, Clinical Hospital of Ribeirão Preto Medical School, University of São Paulo (HCFMRP-USP), São Paulo, Brazil
| | - José Celso Ardengh
- Endoscopy Department, Hospital 9 de Julho, São Paulo, Brazil.,Digestive Endoscopy Section, Department of Surgery and Anatomy, Clinical Hospital of Ribeirão Preto Medical School, University of São Paulo (HCFMRP-USP), São Paulo, Brazil.,Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade de São Paulo, São Paulo, Brazil
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16
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Needle tract seeding and abscess associated with pancreatic fistula after endoscopic ultrasound-guided fine-needle aspiration. Clin J Gastroenterol 2020; 13:1322-1330. [PMID: 32720220 DOI: 10.1007/s12328-020-01188-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/17/2020] [Indexed: 02/07/2023]
Abstract
We present the first report of needle tract seeding with simultaneous abscess associated with pancreatic fistula occurring after endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for pancreatic ductal adenocarcinoma (PDA). A 72-year-old woman complained of fever 18 days after EUS-FNA for PDA of the pancreatic tail with a retention cyst. An abscess associated with pancreatic fistula containing necrotic debris formed in the EUS-FNA needle tract was successfully treated with endoscopic drainage and antibiotics. Distal pancreatectomy with partial gastrectomy was performed after neoadjuvant chemotherapy. Complete resection was achieved but peritoneal lavage cytology was positive for cancer. Pathology of the resected specimen revealed cancer cells invading the gastric submucosa at the EUS-FNA puncture site from the serosal side. The lining of the retention cyst was free of cancer cells. Liver metastases and peritoneal carcinomatosis were seen 3 months after surgery. While needle tract seeding has recently received attention as a complication of EUS-FNA, endoscopists should also be alerted to the possibility of abscess associated with pancreatic fistula after EUS-FNA for PDA.
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17
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Okagawa Y, Kondo T, Tsuji Y, Takayama T, Oiwa S, Yoshida M, Ihara H, Sumiyoshi T, Hirayama M, Kondo H. Natural History of Pancreatic Ductal Adenocarcinoma Diagnosed During Observation of Other Organ Cancers. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1080-1084. [PMID: 31335860 PMCID: PMC6668584 DOI: 10.12659/ajcr.917197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/26/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is a rapidly progressive malignancy that exhibits an extremely poor prognosis, with most cases diagnosed at an advanced stage. To date, few reports have explored the natural history of PDAC, and the period leading up to the detection of PDAC as a tumor with contrast-enhanced computed tomography (CECT) remains unclear. Here, we report 3 PDAC cases diagnosed incidentally by repeating imaging examinations during observation of other organ cancers. CASE REPORT Two patients were undergoing postoperative follow-up for colorectal cancer; owing to the elevation of serum CA19-9 or dilatation of the main pancreatic duct, both cases were finally diagnosed with PDAC. Another patient was administered neoadjuvant chemotherapy for a gastrointestinal stromal tumor; the fluorodeoxyglucose uptake in the pancreas with fluorodeoxyglucose positron emission tomography for the treatment assessment led to the diagnosis of PDAC. All patients underwent frequent CECT for assessment of other diseases, and PDAC became visible with CECT within 3-4 months of the appearance of indirect findings of PDAC. CONCLUSIONS The period leading up to the detection of PDAC as a tumor with CECT was approximately 3-4 months. These cases suggest that additional imaging examinations should be performed when the indirect findings of PDAC are noted. This report adds value to the literature by elucidating the natural course of PDAC.
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Affiliation(s)
- Yutaka Okagawa
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Tomohiro Kondo
- Department of Clinical Oncology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Yasushi Tsuji
- Department of Clinical Oncology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Toshizo Takayama
- Department of Clinical Oncology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Shutaro Oiwa
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Masahiro Yoshida
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Hideyuki Ihara
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Tetsuya Sumiyoshi
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Michiaki Hirayama
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
| | - Hitoshi Kondo
- Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan
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18
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Accuracy of 3-T MRI for Preoperative T Staging of Esophageal Cancer After Neoadjuvant Chemotherapy, With Histopathologic Correlation. AJR Am J Roentgenol 2019; 212:788-795. [PMID: 30673335 DOI: 10.2214/ajr.18.20204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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19
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Yu CY, Chien CH, Hsieh PJ, Chien RN. Cervical esophageal perforation during endoscopic ultrasonography: A retrospective evaluation of frequency, outcome, and patient management. ADVANCES IN DIGESTIVE MEDICINE 2018. [DOI: 10.1002/aid2.13085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Chia-Ying Yu
- Department of Gastroenterology and Hepatology; Keelung Chang Gung Memorial Hospital and University; Keelung Taiwan
| | - Cheng-Hung Chien
- Department of Gastroenterology and Hepatology; Keelung Chang Gung Memorial Hospital and University; Keelung Taiwan
| | - Po-Jen Hsieh
- Department of Gastroenterology and Hepatology; Keelung Chang Gung Memorial Hospital and University; Keelung Taiwan
| | - Rong-Nan Chien
- Department of Gastroenterology and Hepatology; Keelung Chang Gung Memorial Hospital and University; Keelung Taiwan
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20
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Chan FKL, Goh KL, Reddy N, Fujimoto K, Ho KY, Hokimoto S, Jeong YH, Kitazono T, Lee HS, Mahachai V, Tsoi KKF, Wu MS, Yan BP, Sugano K. Management of patients on antithrombotic agents undergoing emergency and elective endoscopy: joint Asian Pacific Association of Gastroenterology (APAGE) and Asian Pacific Society for Digestive Endoscopy (APSDE) practice guidelines. Gut 2018; 67:405-417. [PMID: 29331946 PMCID: PMC5868286 DOI: 10.1136/gutjnl-2017-315131] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 12/06/2017] [Accepted: 12/09/2017] [Indexed: 12/12/2022]
Abstract
This Guideline is a joint official statement of the Asian Pacific Association of Gastroenterology (APAGE) and the Asian Pacific Society for Digestive Endoscopy (APSDE). It was developed in response to the increasing use of antithrombotic agents (antiplatelet agents and anticoagulants) in patients undergoing gastrointestinal (GI) endoscopy in Asia. After reviewing current practice guidelines in Europe and the USA, the joint committee identified unmet needs, noticed inconsistencies, raised doubts about certain recommendations and recognised significant discrepancies in clinical practice between different regions. We developed this joint official statement based on a systematic review of the literature, critical appraisal of existing guidelines and expert consensus using a two-stage modified Delphi process. This joint APAGE-APSDE Practice Guideline is intended to be an educational tool that assists clinicians in improving care for patients on antithrombotics who require emergency or elective GI endoscopy in the Asian Pacific region.
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Affiliation(s)
- Francis K L Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Khean-Lee Goh
- Department of Gastroenterology and Hepatology, University of Malaya, Kuala Lumpur, Malaysia
| | - Nageshwar Reddy
- Asian Healthcare Foundation, AAll India Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
| | - Kazuma Fujimoto
- Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical College, Saga, Japan
| | - Khek Yu Ho
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Singapore, Singapore, Singapore
| | - Seiji Hokimoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Young-Hoon Jeong
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang, Republic of Korea
| | | | - Hong Sik Lee
- Department of Gastroenterology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Varocha Mahachai
- Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kelvin K F Tsoi
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Bryan P Yan
- Department of Medicine and Therapeutics, Institute of Vascular Research, The Chinese University of Hong Kong, Hong Kong, China
| | - Kentaro Sugano
- Department of Medicine, Division of Gastroenterology, Jichi Medical School, Tochigi, Japan
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21
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Lee KH, Kim EY, Cho J, Kang D, Bang S, Kim HK, Kim GH, Choi HJ, Han JH, Jeon SW, Ryu JK, Moon JS, Lee TH, Cho JW, Kim TH, Cheon YK, Park CH, Lee JK, Moon JH, Cho CM. Risk factors associated with adverse events during endoscopic ultrasound-guided tissue sampling. PLoS One 2017; 12:e0189347. [PMID: 29236743 PMCID: PMC5728556 DOI: 10.1371/journal.pone.0189347] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 11/24/2017] [Indexed: 12/14/2022] Open
Abstract
Background and aim Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is commonly used to obtain tissue external to the gastrointestinal tract. EUS-FNA is relatively safe, but occasionally adverse events have been reported. There is scarcity of data on risk factors of adverse events. The aim of this study is to identify risk factors associated with EUS-FNA. Methods In this multicenter case-control study, we retrospectively reviewed 4,097 cases between 2009 and 2012 at 15 hospitals in Korea. Among the patients there were 104 cases (2.5%) who had adverse events of which 12 (0.29%) were severe. We matched 520 controls (1:5 ratios) stratified by hospital to analyze the potential risk factors. Results The most common adverse events were pancreatitis (45/104, 43.3%) and infection (46/104, 44.2%). Endoscopic retrograde cholangiopancreatography (ERCP) on the same day was a risk factor of all adverse events [OR = 2.41, 95% CI (1.41, 4.12)], pancreatitis [OR = 2.31, 95% CI (1.02, 5.25)], and infection [OR = 2.75, 95% CI (1.31, 5.78)]. More than 15 to-and-fro movements during puncture increased the risk of pancreatitis [OR = 2.30, 95% CI (1.11, 4.77)] and infection [OR = 3.65, 95% CI (1.55, 8.59)]. A higher number of punctures was positively correlated with pancreatitis [OR = 1.34, 95% CI (1.08, 1.67)] but negatively correlated with infection [OR = 0.66, 95% CI (0.48, 0.89)]. Conclusions EUS-FNA is a safe procedure in which serious adverse events are rare. We define some risk factors of adverse events during EUS-FNA, including ERCP on the same day, a higher number of punctures, and more than 15 to-and-fro movements.
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Affiliation(s)
- Kwang Hyuck Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Science & Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Eun Young Kim
- Department of Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
- * E-mail:
| | - Juhee Cho
- Department of Health Science & Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health, Behavior and Society and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Danbee Kang
- Department of Health Science & Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seungmin Bang
- Department of Medicine, Yonsei University School of Medicine, Seoul, Korea
| | - Hyung Kil Kim
- Department of Medicine, Inha University School of Medicine, Incheon, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hyun Jong Choi
- Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Joung-Ho Han
- Department of Medicine, Chungbuk National University School of Medicine, Cheongju, Korea
| | - Seong Woo Jeon
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Ji Kon Ryu
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Seop Moon
- Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea
| | - Tae Hee Lee
- Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jin Woong Cho
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Tae Hyeon Kim
- Department of Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Young Koog Cheon
- Department of Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Chang-Hwan Park
- Department of Medicine, Chonnam National University School of Medicine, Gwangju, Korea
| | - Jong Kyun Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Ho Moon
- Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Chang Min Cho
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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22
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Qu J, Zhang H, Wang Z, Zhang F, Liu H, Ding Z, Li Y, Ma J, Zhang Z, Zhang S, Dong Y, Jiang L, Zhang W, Grimm R, Kiefer B, Kamel IR, Qin J, Li H. Comparison between free-breathing radial VIBE on 3-T MRI and endoscopic ultrasound for preoperative T staging of resectable oesophageal cancer, with histopathological correlation. Eur Radiol 2017; 28:780-787. [PMID: 28799124 DOI: 10.1007/s00330-017-4963-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/04/2017] [Accepted: 06/22/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To compare the T staging of resectable oesophageal cancer (OC) using radial VIBE (r-VIBE) and endoscopic ultrasound (EUS) with pathological confirmation of the T stage. METHODS Forty-three patients with endoscopically proven OC and indeterminate T1/T2/T3/T4a stage by computed tomography (CT) and EUS were imaged on a 3-T magnetic resonance imaging (MRI) scanner. T stage was scored on MRI and EUS by two independent radiologists and one endoscopist, respectively, and compared with postoperative pathological findings. T staging agreement between r-VIBE and EUS with postoperative pathological T staging was analysed by a kappa test. RESULTS EUS and pathological T staging showed agreement of 69.8% (30/43). Radial VIBE and pathological T staging agreement was 86.0% (37/43) and 90.7% (39/43) for readers 1 and 2, respectively. High accuracy for T1/T2 stage was obtained for both r-VIBE readers (90.5% and 100% for reader 1 and reader 2, respectively) and EUS reader (100%). For T3/T4, r-VIBE showed accuracy of 81.8% and 90.9% for reader 1 and reader 2, respectively, while for EUS, accuracy was only 68.2% compared with pathological T staging. CONCLUSIONS Contrast-enhanced r-VIBE is comparable to EUS in T staging of resectable OC with stage of T1/T2, and is superior to EUS in staging of T3/T4 lesions. KEY POINTS • Radial VIBE may be useful in preoperative T staging of OC • Accuracy of staging on r-VIBE is higher in T1/2 than in T3/4 • Accuracy of EUS was 100% and 68.2% for T1/T2 and T3/T4 stage • Inter-reader agreement of T staging for r-VIBE was good.
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Affiliation(s)
- Jinrong Qu
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008
| | - Hongkai Zhang
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008
| | - Zhaoqi Wang
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008
| | - Fengguang Zhang
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008
| | - Hui Liu
- NEA MR Collaboration, Siemens Ltd., China, Shanghai, China, 201318
| | - Zhidan Ding
- Department of Thoracic surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008
| | - Yin Li
- Department of Thoracic surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008
| | - Jie Ma
- Department of Pathology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008
| | - Zhongxian Zhang
- Department of Pathology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008
| | - Shouning Zhang
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008
| | - Yafeng Dong
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008
| | - Lina Jiang
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008
| | - Wei Zhang
- Department of Endoscopic Ultrasound, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008
| | - Robert Grimm
- MR-Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany, 91052
| | - Berthold Kiefer
- MR-Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany, 91052
| | - Ihab R Kamel
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205-2196, USA
| | - Jianjun Qin
- Department of Thoracic surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008.
| | - Hailiang Li
- Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China, 450008.
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Kang SK, Hoffman D, Ferket B, Kim MI, Braithwaite RS. Risk-stratified versus Non–Risk-stratified Diagnostic Testing for Management of Suspected Acute Biliary Obstruction: Comparative Effectiveness, Costs, and the Role of MR Cholangiopancreatography. Radiology 2017; 284:468-481. [DOI: 10.1148/radiol.2017161714] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Stella K. Kang
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., D.H.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K., R.S.B.); Institute for Healthcare Delivery Science, Department of Population Health Science and Policy (B.F.), and Department of Medicine, Division of Gastroenterology (M.I.K.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Medicine, NYU Medical Center, New York, NY (R.S.B.)
| | - David Hoffman
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., D.H.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K., R.S.B.); Institute for Healthcare Delivery Science, Department of Population Health Science and Policy (B.F.), and Department of Medicine, Division of Gastroenterology (M.I.K.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Medicine, NYU Medical Center, New York, NY (R.S.B.)
| | - Bart Ferket
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., D.H.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K., R.S.B.); Institute for Healthcare Delivery Science, Department of Population Health Science and Policy (B.F.), and Department of Medicine, Division of Gastroenterology (M.I.K.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Medicine, NYU Medical Center, New York, NY (R.S.B.)
| | - Michelle I. Kim
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., D.H.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K., R.S.B.); Institute for Healthcare Delivery Science, Department of Population Health Science and Policy (B.F.), and Department of Medicine, Division of Gastroenterology (M.I.K.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Medicine, NYU Medical Center, New York, NY (R.S.B.)
| | - R. Scott Braithwaite
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., D.H.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K., R.S.B.); Institute for Healthcare Delivery Science, Department of Population Health Science and Policy (B.F.), and Department of Medicine, Division of Gastroenterology (M.I.K.), Icahn School of Medicine at Mount Sinai, New York, NY; and Department of Medicine, NYU Medical Center, New York, NY (R.S.B.)
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24
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Ahn HJ, Lee SJ, Park JK, Jun BG, Seo HI, Han KH, Kim YD, Jeong WJ, Cheon GJ. Catheter probe endoscopic ultrasonography by using cold lubricating jelly-filled method for esophageal subepithelial tumors. Dis Esophagus 2017; 30:1-6. [PMID: 28575248 DOI: 10.1093/dote/dox035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/29/2017] [Indexed: 12/11/2022]
Abstract
Catheter probe endoscopic ultrasonography (C-EUS) by ultrasonographic jelly-filled method has been used to evaluate esophageal subepithelial tumors (SETs). Ultrasonographic jelly is safe on the skin, but its internal safety has not been demonstrated. The jelly stored at room temperature is easily injected into the esophagus through the instrument channel of the endoscope. However, using jelly stored at room temperature remains problematic because the jelly is drained rapidly. We used cold lubricating jelly and an intravenous extension tube to resolve these problems. In this study, we evaluated the safety and efficacy of cold lubricating jelly-filled method. The medical records of patients who underwent C-EUS by using water or cold lubricating jelly-filled method for esophageal SETs from March 2013 to September 2016 in Gangneung Asan hospital were reviewed. Clinical characteristics and EUS findings were evaluated retrospectively. Image quality and procedure time between water and cold lubricating jelly-filled method were compared retrospectively. This study included 138 patients (74 males, 64 females) with esophageal SET with a mean age of 57.1 ± 11.1 years. Thirty-four patients had lesions in the upper esophagus, 58 patients had lesions in the middle esophagus, and 46 patients had lesions in the lower esophagus. The EUS diagnoses were leiomyoma (82.6%), hemangioma (4.3%), extrinsic compressive lesion (3.6%), granulosa cell tumor (2.9%), ectopic calcification (1.4%), cyst (1.4%), lipoma (0.7%), varix (0.7%), and inconclusive lesion (2.2%). The mean image score in the cold lubricating jelly filled-method group was higher than that in the water-filled method group (3.2 ± 0.7 vs. 2.8 ± 0.7, P = 0.002). The procedure time in the cold lubricating jelly filled-method group was shorter than that in the water-filled method group (10 minutes 27 seconds ± 4 minutes 22 seconds versus 13 minutes 20 seconds ± 6 minutes 20 seconds, P = 0.045). No procedure-related complication was observed. C-EUS using the cold lubricating jelly-filled method seems to provide better image quality and shorter procedure time compared with C-EUS using the water-filled method.
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Affiliation(s)
- H J Ahn
- Department of Internal Medicine, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - S J Lee
- Department of Internal Medicine, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - J K Park
- Department of Internal Medicine, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - B G Jun
- Department of Internal Medicine, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - H I Seo
- Department of Internal Medicine, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - K H Han
- Department of Internal Medicine, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Y D Kim
- Department of Internal Medicine, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - W J Jeong
- Department of Internal Medicine, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - G J Cheon
- Department of Internal Medicine, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
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25
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Campbell JA, Irvine AJ, Hopper AD. Endoscopic ultrasound sedation in the United Kingdom: Is life without propofol tolerable? World J Gastroenterol 2017; 23:560-562. [PMID: 28210094 PMCID: PMC5291863 DOI: 10.3748/wjg.v23.i3.560] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/15/2016] [Accepted: 12/02/2016] [Indexed: 02/06/2023] Open
Abstract
There is compelling evidence to support the quality, cost effectiveness and safety profile of non-anesthesiologist-administered propofol for endoscopic ultrasound (EUS). However in the United Kingdom, it is recommended that the administration and monitoring of propofol sedation for endoscopic procedures should be the responsibility of a dedicated and appropriately trained anaesthetist only. The majority of United Kingdom EUS procedures are performed with opiate and benzodiazepine sedation rather than anaesthetist led propofol lists due to anaesthetist resource availability. We sought to prospectively determine the tolerability and safety of EUS with benzodiazepine and opiate sedation in single United Kingdom centre. Two hundred consecutive patients undergoing either EUS or oesophago-gastroduodenoscopy (OGD) with conscious sedation were prospectively recruited with a 1:1 enrolment ratio. Patients completed questionnaires pre and post procedure detailing anticipated and actual pain experienced on a 1-10 visual analogue scale. Demographics, procedure duration, sedation doses and willingness to repeat the procedure were also recorded. EUS procedures lasted significantly longer than OGDs (15 min vs 6 min, P < 0.0001), however, there was no difference in anticipated pain scores between the groups (EUS 3.37/10 vs OGD 3.47/10, P = 0.46). Pain scores indicated EUS was better tolerated than OGD (1.16/10 vs 1.88/10, P = 0.03) although higher doses of sedation were used for EUS procedures. There were no complications identified in either group. We feel our study demonstrates that the tolerability of EUS with opiate and benzodiazepine sedation is acceptable.
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26
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Inoue T, Okumura F, Sano H, Kobayashi Y, Ishii N, Suzuki Y, Fukusada S, Kachi K, Ozeki T, Anbe K, Iwasaki H, Mizushima T, Ito K, Yoneda M. Bleeding risk of endoscopic ultrasound-guided fine-needle aspiration in patients undergoing antithrombotic therapy. Dig Endosc 2017; 29:91-96. [PMID: 27305322 DOI: 10.1111/den.12687] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/15/2016] [Accepted: 06/10/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Bleeding events related to endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) are rare. However, for patients treated with antithrombotic agents, the bleeding risk of EUS-FNA is uncertain. Hence, the aim of this study was to assess the bleeding event rate associated with EUS-FNA in patients receiving antithrombotic treatment. METHODS A retrospective study was conducted in 742 consecutive patients who underwent EUS-FNA for solid lesions between 2008 and 2015. We compared the bleeding event rates among patients who were not administered antithrombotic agents, those whose agent use was discontinued, those who continued treatment with aspirin or cilostazol, and those who were administered heparin as a replacement. RESULTS There were 131 patients (17.7 %) treated with antithrombotic agents. Seven experienced bleeding events, and the overall bleeding event rate was 0.9 % (7/742). All bleeding events were intraoperative; there were no postoperative bleeding episodes. Subgroup analysis by antithrombotic agent revealed bleeding event rates of 1.0 % (6/611), 0 % (0/62), 1.6 % (1/61), and 0 % (0/8) for the non-administration, discontinuation of agents, continuation of aspirin or cilostazol, and heparin replacement groups, respectively. Only one severe bleeding event necessitated hemostatic treatment (1/742; 0.1 %); this occurred in a patient in the non-administration group, and there were no severe bleeding events in patients receiving antithrombotic treatment. CONCLUSIONS The present study found a low incidence of EUS-FNA-related bleeding in patients receiving antithrombotic treatment. The bleeding event rate was low even in patients who underwent EUS-FNA while continuing aspirin or cilostazol.
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Affiliation(s)
- Tadahisa Inoue
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan.,Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Fumihiro Okumura
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Hitoshi Sano
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Yuji Kobayashi
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Norimitsu Ishii
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yuta Suzuki
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Shigeki Fukusada
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Kenta Kachi
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Takanori Ozeki
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Kaiki Anbe
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Hiroyasu Iwasaki
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Takashi Mizushima
- Department of Gastroenterology, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Kiyoaki Ito
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Masashi Yoneda
- Department of Gastroenterology, Aichi Medical University School of Medicine, Nagakute, Japan
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27
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Storm AC, Lee LS. Endoscopic ultrasound-guided techniques for diagnosing pancreatic mass lesions: Can we do better? World J Gastroenterol 2016; 22:8658-8669. [PMID: 27818584 PMCID: PMC5075543 DOI: 10.3748/wjg.v22.i39.8658] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/24/2016] [Accepted: 09/14/2016] [Indexed: 02/06/2023] Open
Abstract
The diagnostic approach to a possible pancreatic mass lesion relies first upon various non-invasive imaging modalities, including computed tomography, ultrasound, and magnetic resonance imaging techniques. Once a suspect lesion has been identified, tissue acquisition for characterization of the lesion is often paramount in developing an individualized therapeutic approach. Given the high prevalence and mortality associated with pancreatic cancer, an ideal approach to diagnosing pancreatic mass lesions would be safe, highly sensitive, and reproducible across various practice settings. Tools, in addition to radiologic imaging, currently employed in the initial evaluation of a patient with a pancreatic mass lesion include serum tumor markers, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). EUS-FNA has grown to become the gold standard in tissue diagnosis of pancreatic lesions.
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28
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Lakhtakia S. Complications of diagnostic and therapeutic Endoscopic Ultrasound. Best Pract Res Clin Gastroenterol 2016; 30:807-823. [PMID: 27931638 DOI: 10.1016/j.bpg.2016.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/06/2016] [Accepted: 10/21/2016] [Indexed: 01/31/2023]
Abstract
Endoscopic Ultrasound (EUS) provides the unique opportunity to visualize, interrogate and intervene gastrointestinal (GI) luminal, mural or peri-luminal structures and pathology with negligible adverse effects. Diagnostic, upper GI and rectal EUS is feasible, extremely safe, and efficacious. Most EUS guided interventions are safe, effective and minimally invasive, compared to peers in the percutaneous radiological or surgical procedures. As with any endoscopic procedure, EUS and its guided interventions may be accompanied by adverse events. EUS related complications are generally infrequent in expert hands, and mainly include bleeding and perforation. However, the nature and severity of adverse events associated with each EUS guided procedure are unique. Hence, it is paramount for endosonographer to have sufficient knowledge of the indications, techniques, and potential risks involved before contemplating any given procedure. Most common intervention with EUS is transmural fine needle aspiration (FNA), which is an extremely safe procedure. EUS guided drainage procedures are rapidly evolving with newer devices and methods being employed. Among them, EUS guided drainage of pancreatic fluid collection-pseudocyst or walled off necrosis (WON), has largely replaced other methods (surgical, percutaneous or non-EUS endoscopic) with acceptable complications. Currently, dedicated metal stents are more widely used compared to plastic stents for drainage of PFC, especially WON. EUS has made a definite impact in biliary access and drainage of obstructed biliary system, in patients where ERCP has failed or is technically not possible, closely competing with percutaneous biliary drainage. In spite of some complications, recent improvement in devices for bilio-enteric fistula creation and stent designs, has added to its safety and efficacy. EUS guided pancreatic duct drainage remains the most challenging of EUS guided interventions where in-roads are being made.
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Affiliation(s)
- Sundeep Lakhtakia
- Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, Telangana, 500082, India.
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29
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Lochhead P, Phull P. Initial experience of direct-to-test endoscopic ultrasonography for suspected choledocholithiasis. Scott Med J 2015; 60:85-9. [PMID: 25673357 DOI: 10.1177/0036933015572276] [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: 11/16/2022]
Abstract
BACKGROUND AND AIMS Endoscopic ultrasound has become an invaluable tool in the investigation of patients with suspected pancreatobiliary disease. We set out to determine whether a "direct-to-test" endoscopic ultrasound procedure could be offered to selected patients with suspected choledocholithiasis. METHODS AND RESULTS We included patients referred to our general gastroenterology service with clinical history, symptomatology and/or laboratory results compatible with choledocholithiais. Almost all patients had already had a transabdominal ultrasound performed at the request of their general practitioner. All patients underwent direct-to-test day-case endoscopic ultrasound under conscious sedation. Procedures were performed by a single practitioner using an oblique-viewing radial echoendoscope. The diagnostic yield and frequencies of discharge, onward referral and follow-up were determined. Overall diagnostic yield of direct-to-test endoscopic ultrasound was 61%. The most common diagnoses were cholelithiasis (18%) and choledocholithiasis (11%); one periampullary cancer was also detected. A definitive outcome (discharge or referral for a therapeutic procedure) occurred in 14 of 28 patients (50%). The remaining 14 patients underwent further out-patient evaluation. Eventual diagnoses in this group included autoimmune hepatitis, primary biliary cirrhosis and drug-induced hepatitis. CONCLUSIONS For patients with suspected biliary disease, direct-to-test endoscopic ultrasound has a high diagnostic yield, and may be an appropriate mode of investigation.
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Affiliation(s)
- Paul Lochhead
- Clinical Lecturer, Gastrointestinal Research Group, Institute of Medical Sciences, University of Aberdeen, UK; Gastrointestinal and Liver Service, Aberdeen Royal Infirmary, UK
| | - Perminder Phull
- Consultant Gastroenterologist, Gastrointestinal and Liver Service, Aberdeen Royal Infirmary, UK
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30
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Wani S, Wallace MB, Cohen J, Pike IM, Adler DG, Kochman ML, Lieb JG, Park WG, Rizk MK, Sawhney MS, Shaheen NJ, Tokar JL. Quality indicators for EUS. Am J Gastroenterol 2015; 110:102-13. [PMID: 25448871 DOI: 10.1038/ajg.2014.387] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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31
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Wani S, Wallace MB, Cohen J, Pike IM, Adler DG, Kochman ML, Lieb JG, Park WG, Rizk MK, Sawhney MS, Shaheen NJ, Tokar JL. Quality indicators for EUS. Gastrointest Endosc 2015; 81:67-80. [PMID: 25480097 DOI: 10.1016/j.gie.2014.07.054] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 07/24/2014] [Indexed: 02/08/2023]
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32
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Fujii LL, Levy MJ. Basic techniques in endoscopic ultrasound-guided fine needle aspiration for solid lesions: Adverse events and avoiding them. Endosc Ultrasound 2014; 3:35-45. [PMID: 24949409 PMCID: PMC4063261 DOI: 10.4103/2303-9027.123006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 11/14/2013] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) is often the preferred technique for tissue acquisition in the diagnosis of suspected intrathoracic and intraabdominal pathology. Although EUS FNA is a safe and accurate procedure, it has been associated with a low risk of adverse events. The unique properties of the echoendoscope and its ability to acquire tissue outside of the gastrointestinal lumen impart risks that are not associated with routine endoscopic procedures. In this review, we discuss the risk of perforation related to the echoendoscope itself and adverse events related to FNA of solid masses including infections, bleeding, pancreatitis and pancreatic duct leak, bile duct leak and tumor seeding. We also provide tips on how to avoid the most common adverse events related to EUS-FNA.
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Affiliation(s)
- Larissa L Fujii
- Mayo Clinic, Division of Gastroenterology and Hepatology, 200 1 St. SW, Rochester, MN 55905, USA
| | - Michael J Levy
- Mayo Clinic, Division of Gastroenterology and Hepatology, 200 1 St. SW, Rochester, MN 55905, USA
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Buscarini E, Pezzilli R, Cannizzaro R, De Angelis C, Gion M, Morana G, Zamboni G, Arcidiacono P, Balzano G, Barresi L, Basso D, Bocus P, Calculli L, Capurso G, Canzonieri V, Casadei R, Crippa S, D'Onofrio M, Frulloni L, Fusaroli P, Manfredi G, Pacchioni D, Pasquali C, Rocca R, Ventrucci M, Venturini S, Villanacci V, Zerbi A, Falconi M. Italian consensus guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms. Dig Liver Dis 2014; 46:479-93. [PMID: 24809235 DOI: 10.1016/j.dld.2013.12.019] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/07/2013] [Accepted: 12/30/2013] [Indexed: 12/11/2022]
Abstract
This report contains clinically oriented guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms in patients fit for treatment. The statements were elaborated by working groups of experts by searching and analysing the literature, and then underwent a consensus process using a modified Delphi procedure. The statements report recommendations regarding the most appropriate use and timing of various imaging techniques and of endoscopic ultrasound, the role of circulating and intracystic markers and the pathologic evaluation for the diagnosis and follow-up of cystic pancreatic neoplasms.
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Affiliation(s)
| | | | | | - Raffaele Pezzilli
- Pancreas Unit, Department of Digestive Diseases and Internal Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Claudio De Angelis
- Gastroenterology and Hepatology Department, A.O. San Giovanni Battista/Molinette, University of Turin, Turin, Italy
| | - Massimo Gion
- Department of Clinical Pathology, AULSS 12, Venice, Italy
| | - Giovanni Morana
- Department of Diagnostic Radiology, Ospedale Cà Foncello, Treviso, Italy
| | | | - Paolo Arcidiacono
- Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute, Italy
| | - Gianpaolo Balzano
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Barresi
- Gastroenterology and Endoscopy Unit, ISMETT, Palermo, Italy
| | - Daniela Basso
- Department of Laboratory Medicine, University Hospital, Padua, Italy
| | - Paolo Bocus
- Gastroenterology Unit, Ospedale Sacro Cuore-Don Calabria, Negrar, Verona, Italy
| | - Lucia Calculli
- Department of Radiology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Gabriele Capurso
- Digestive and Liver Disease Unit, Faculty of Medicine and Psychology, Sapienza University of Rome at S. Andrea Hospital, Rome, Italy
| | | | - Riccardo Casadei
- Department of Surgery, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Stefano Crippa
- Department of Surgery, Pancreas Unit, Università Politecnica delle Marche, Ancona, Italy
| | - Mirko D'Onofrio
- Department of Radiology, University Hospital G.B. Rossi, University of Verona, Verona, Italy
| | - Luca Frulloni
- Department of Surgical and Gastroenterological Sciences, University of Verona, Verona, Italy
| | - Pietro Fusaroli
- Department of Clinical Medicine, University of Bologna, Bologna, Italy
| | | | | | - Claudio Pasquali
- Surgery Unit IV, Department of Medical and Surgical Sciences, University of Padua, Padua, Italy
| | - Rodolfo Rocca
- Gastroenterology Unit, Mauriziano Hospital, Turin, Italy
| | - Maurizio Ventrucci
- Department of Internal Medicine and Gastroenterology, Bentivoglio Hospital, Bologna, Italy
| | - Silvia Venturini
- Department of Diagnostic Radiology, Ospedale Cà Foncello, Treviso, Italy
| | | | - Alessandro Zerbi
- Pancreatic Surgery, Department of Surgery, Humanitas Clinical and Research Center, Milan, Italy
| | - Massimo Falconi
- Department of Surgery, Pancreas Unit, Università Politecnica delle Marche, Ancona, 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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Tarantino I, Fabbri C, Di Mitri R, Pagano N, Barresi L, Mocciaro F, Maimone A, Curcio G, Repici A, Traina M. Complications of endoscopic ultrasound fine needle aspiration on pancreatic cystic lesions: final results from a large prospective multicenter study. Dig Liver Dis 2014; 46:41-4. [PMID: 24054767 DOI: 10.1016/j.dld.2013.08.134] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/01/2013] [Accepted: 08/11/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic ultrasound-guided fine needle aspiration of pancreatic cystic lesions has been reported to have a higher complication rate than that of solid lesions, but the real complication rate is unknown. Aim of the study was to identify the complication rate of endoscopic ultrasound-guided fine needle aspiration and related risk factors. METHODS Prospective multicenter study at four referral centres. Data were collected from January 2010 to July 2012, searching for all adverse events related to guided fine needle aspiration. All complications occurring up to day 90 were recorded. RESULTS 298 patients (43.9% male, mean age 63.2 ± 15.4 years) underwent endoscopic ultrasound-guided needle aspiration of pancreatic cystic lesions. Mean size was 34.1 ± 9 mm. Adverse events occurred in 18 patients (6%): mild complications in 12/18 (66.6%), and moderate complications in 6/18 (33.3%). Seven were immediate, 6 early, and 5 late. All resolved with medical therapy. CONCLUSIONS Endoscopic ultrasound-guided fine needle aspiration of pancreatic cystic lesions has been found to be associated with a higher complication rate than for solid lesions; however, the risk rate is acceptable considering the complication grade and the important diagnostic role of the technique in the management of pancreatic cystic lesions.
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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.
| | - Carlo Fabbri
- Gastroenterology Department, AUSL Bologna, Bellaria-Maggiore Hospital, Bologna, Italy
| | - Roberto Di Mitri
- Gastroenterology Department, Civico-A.R.N.A.S. Hospital, Palermo, Italy
| | - Nico Pagano
- Gastroenterology Department, Humanitas Irccs, Rozzano, Milan, Italy
| | - Luca Barresi
- Gastroenterology Department, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Palermo, Italy
| | - Filippo Mocciaro
- Gastroenterology Department, Civico-A.R.N.A.S. Hospital, Palermo, Italy
| | | | - Gabriele Curcio
- Gastroenterology Department, ISMETT/UPMC (Mediterranean Institute for Transplantation and Advanced Specialized Therapies/University of Pittsburgh Medical Center in Italy), Palermo, 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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Factors predictive of adverse events associated with endoscopic ultrasound-guided fine needle aspiration of pancreatic solid lesions. Dig Dis Sci 2013; 58:2093-9. [PMID: 23423501 PMCID: PMC3695684 DOI: 10.1007/s10620-013-2590-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 01/24/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) provides high diagnostic accuracy with a low incidence of procedural complications. However, it occasionally causes serious complications, and factors that increase the susceptibility to such adverse events remain unknown. AIMS We aimed to examine post-procedural events and determine risk factors associated with EUS-FNA of pancreatic solid lesions. METHODS This single-center retrospective study included 316 consecutive patients with pancreatic solid lesions who underwent 327 EUS-FNA procedures from April 2003 to September 2011. We registered all patients undergoing EUS-FNA in the database and retrospectively ascertained the presence/absence of post-procedural adverse events. RESULTS The incidence of post-procedural adverse events, including moderate to mild pancreatitis, mild abdominal pain, and mild bleeding, was 3.4 %. Univariate analysis showed that the incidence of post-procedural events was significantly increased in patients with tumors less than or equal to 20 mm in diameter (P < 0.001), those with pancreatic neuroendocrine tumors (PNET) (P = 0.012), and patients who had intervening normal pancreas for accessing the lesion (P = 0.048). Multivariate analysis identified tumors measuring less than or equal to 20 mm in diameter (OR 18.48; 95 % CI 3.55-96.17) and case of PNETs (OR 36.50; 95 % CI 1.73-771.83) were an independent risk factors. CONCLUSIONS EUS-FNA of pancreatic solid lesions is a safe procedure. However, pancreatic lesions with small diameters and pancreatic neuroendocrine tumors are important factors associated with adverse events after EUS-FNA.
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Jenssen C, Alvarez-Sánchez MV, Napoléon B, Faiss S. Diagnostic endoscopic ultrasonography: Assessment of safety and prevention of complications. World J Gastroenterol 2012; 18:4659-76. [PMID: 23002335 PMCID: PMC3442204 DOI: 10.3748/wjg.v18.i34.4659] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 07/06/2012] [Accepted: 07/18/2012] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients’ specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% of patients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications.
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Endoscopy in the patient on antithrombotic therapy. Curr Opin Gastroenterol 2012; 28:432-41. [PMID: 22885943 DOI: 10.1097/mog.0b013e328355e26f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW The management of antithrombotics during the periendoscopic period is a common clinical problem. This review focuses on recent literature addressing this issue, primarily on articles published from 2009 to 2012. RECENT FINDINGS A large proportion of the studies retrieved focused on the effect of antithrombotics on bleeding risk following diagnostic endoscopy, polypectomy, endoscopic mucosal resection, and submucosal dissection, whereas studies involving other endoscopic procedures were scarce. Recent American and European guidelines direct the management of antithrombotic therapy in patients undergoing endoscopy according to the procedure's risk of bleeding and the patient's thromboembolic risk. The difficulty in determining a priori the need for endotherapy and hence appropriate classification of risk of bleeding prior to the procedure is a potential limitation of such classification. Moreover, most studies have primarily addressed the risk of immediate or early bleeding by proposing interruption of antithrombotic therapy prior to endotherapy, and few have focused on the risk of delayed bleeding and the optimal time for resumption of these agents following high-risk procedures. SUMMARY Management of patients on antithrombotics remains complex, especially in high-risk settings. Existing guidelines are valuable but should not be a substitute for a careful personalized risk assessment strategy involving patient and physician.
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Incidence of hyperamylasemia after endoscopic ultrasound-guided fine needle aspiration of pancreatic lesions: a multicenter study from China. Pancreas 2012; 41:712-6. [PMID: 22481292 DOI: 10.1097/mpa.0b013e31823e70cb] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES There have been few reports regarding the incidence of hyperamylasemia after endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). In particular, the potential risk factors involved in the development of hyperamylasemia have not been analyzed owing to the small number of cases reported. The aim of this study was to evaluate hyperamylasemia and associated risk factors after EUS-FNA of a large sample of pancreatic lesions. METHODS Patients who underwent EUS-FNA for treatment of a pancreatic lesion were recruited from 6 medical centers in China. RESULTS A total of 1023 patients presenting with pancreatic lesions between January 2004 and June 2008 were enrolled in this study, with 48 (4.7%) of the 1023 patients presenting with hyperamylasemia 3 hours after the procedure. These patients had a mean ± SD serum amylase level of 331.64 ± 138.60 UI/L. With the use of unconditional logistic regression analysis, the incidence of hyperamylasemia was found to be affected by the type of cystic lesion present and the gauge of the needle used. In 4 (0.4%) of the 1023 patients, acute pancreatitis developed. CONCLUSIONS The overall incidence of hyperamylasemia after EUS-FNA is relatively low. However, the type of cystic lesion present and the gauge of the needle (19G) used for EUS-FNA may represent risk factors for the incidence of hyperamylasemia.
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van Zoonen M, van Oijen MGH, van Leeuwen MS, van Hillegersberg R, Siersema PD, Vleggaar FP. Low impact of staging EUS for determining surgical resectability in esophageal cancer. Surg Endosc 2012; 26:2828-34. [PMID: 22692460 DOI: 10.1007/s00464-012-2254-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 03/19/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although studies have shown that EUS has a high sensitivity and specificity for T and N staging, the value of EUS for staging tumors as resectable or nonresectable after CT of the chest and abdomen and US neck assessment, is largely unknown. This study was designed to assess the diagnostic value of EUS for determining resectability of esophageal cancer. METHODS A retrospective analysis of all consecutive patients with esophageal carcinoma who underwent staging EUS, CT, and US. Tumors were considered resectable when there was no evidence of metastases or ingrowth in adjacent structures. Sensitivity, specificity, positive (PPV), and negative (NPV) predictive value of CT/US neck and CT/US neck + EUS for predicting surgical resectability were calculated. PPVs of CT/US alone and CT/US + EUS together were compared for assessing the diagnostic value of EUS. RESULTS In total, 211 patients (155 men; mean age of 64 ± 9.4 years) were included, of which 176 (83 %) underwent all three staging investigations. Based on preoperative staging, 173 (82 %) patients were considered resectable and 38 (18 %) nonresectable. Of all 173 initially resectable patients, 145 were operated on. Of these patients, five (3.4 %) tumors were found nonresectable during surgery. Postoperative sensitivity, specificity, PPV, and NPV of CT/US and CT/US + EUS for predicting surgical resectability were 88 versus 87 %, 20 versus 40 %, 97 versus 98 %, and 6 versus 10 %, respectively. CONCLUSIONS Although EUS adds to the specificity of preoperative esophageal cancer staging after CT chest and abdomen, and US of the neck have been performed, the overall added value of EUS is limited.
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Affiliation(s)
- M van Zoonen
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
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Patient preferences after endoscopic ultrasound with fine needle aspiration (EUS-FNA) diagnosis of pancreas cancer: rapid communication valued over long-term relationships. Pancreas 2011; 40:680-1. [PMID: 21602735 DOI: 10.1097/mpa.0b013e3182197359] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Endoscopic ultrasound with fine needle aspiration (EUS-FNA) is used for the diagnosis of pancreatic malignancy. However, there are limited data as to patient preferences regarding the delivery of cancer diagnoses. OBJECTIVE This study aimed to assess if patients had met the endosonographer before their EUS, their suspicion of having cancer, and whether they would like the cytology results given to them by their referring physician (with whom they had a previous relationship) or the endosonographer. This question was also asked with respect to the timing of receiving cytology results. METHODS A total of 131 patients with a suspected solid pancreatic mass undergoing EUS-FNA at 2 tertiary referral centers were prospectively enrolled and completed a preprocedure questionnaire. RESULTS One hundred twenty patients (92%) had not met the endosonographer before their EUS-FNA, and only 37 patients (28%) thought they had a pancreatic malignancy. Of the 131 patients, 89 (68%) stated that they wanted to hear results from the endosonographer (P = 0.0001) and 100 patients (76%) chose to hear results as soon as possible from the endosonographer (P = 0.001). CONCLUSIONS Our data highlight the importance of the endosonographer's role in the delivery of cancer diagnoses and that patients value expediency of reporting results over long-term physician relationships.
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Ainsworth AP, Pless T, Nielsen HO. Potential impact of adding endoscopic ultrasound to standard imaging procedures in the preoperative assessment of resectability in patients with liver tumors. Scand J Gastroenterol 2011; 46:1020-3. [PMID: 21504382 DOI: 10.3109/00365521.2011.574727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The value of endoscopic ultrasonography (EUS) in patients with liver diseases is limitedly described. The aim of this study was to evaluate the potential impact of adding EUS to standard imaging procedures in the evaluation of resectability in patients with liver tumors. MATERIAL AND METHODS Patients who, based on the findings of CT and/or MRI, had been referred for curative resection of liver tumours were studied. Each patient underwent EUS before the final assessment of resectability, which was done by laparoscopic ultrasound or laparotomy. RESULTS Sixty-four patients were included. Intended curative resection was performed in 19 (30%) patients. Thirty-five (55%) patients were considered to have non-curative malignant disease. In 10 (15%) patients, the tumor was judged to be benign and surgery was not performed. There were no complications related to EUS. The sensitivity, specificity, positive predictive value, and negative predictive value of EUS regarding prediction of non-resectability were 0.24, 0.94, 0.80 and 0.56 (tumor in right lobe), 0.50, 1.0, 1.0 and 0.75 (tumor in left lobe), and 0.60, 0.67, 0.86 and 0.33 (tumors in both lobes), respectively. Sixteen patients (25%) would have had changed their further management, if decision regarding non-resectability had been taken after EUS. DISCUSSION Addition of EUS to a standard imaging set-up based on CT and/or MRI would have changed the management in 25% of the patients otherwise scheduled for resection of suspected liver tumors.
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Skalicky M. The Size of the Papilla of Vater and Its Relation to Its Height in Comparison with the Visibility of the Sphincter of Oddi before and after Cholecystectomy. J Int Med Res 2011; 39:1039-50. [DOI: 10.1177/147323001103900339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
This study investigated the changes in the surface area and height of the papilla of Vater (PV) and the visibility of the sphincter of Oddi complex (SOK) using endoscopic ultrasound (EUS) examinations of 80 patients with symptomatic gallstones before and at 3 and 6 months after cholecystectomy. Following surgery, 50 patients experienced early atypical symptoms characteristic of postcholecystectomy syndrome (PCS) and 30 patients were asymptomatic. The PV measurements were greater in all patients compared with normal reference values and increased significantly from before surgery to 3 months postsurgery. At 6 months postsurgery, both the surface area and height of the PV had significantly decreased to preoperative values but remained higher than normal. The proportion of patients with a visible SOK had increased by 3 months postsurgery but had reduced again by 6 months. There were no significant differences between symptomatic and asymptomatic patients, suggesting that the changes observed in the PV and SOK do not explain the presence of the atypical symptoms of PCS.
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Affiliation(s)
- M Skalicky
- Division of Internal Medicine, University Medical Centre Maribor, Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
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Lee JH, Lee SR, Lee SY, Kim HH, Park JH, Ryu SH, Kim YS, Moon JS. [The usefulness of endoscopic ultrasonography in the diagnosis of choledocholithiasis without common bile duct dilatation]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2010; 56:97-102. [PMID: 20729621 DOI: 10.4166/kjg.2010.56.2.97] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Endoscopic retrograde cholangiopancreatography (ERCP) is the most accurate modality in diagnosis of choledocholithiasis. However, it carries some complications. Endoscopic ultrasonography (EUS) is less invasive than ERCP and used for the diagnosis of choledocholithiasis. Recent studies showed that a usefulness of EUS for the diagnosis of small choledocholithiasis without common bile duct (CBD) dilatation. For such a reason, ERCP is being replaced by EUS in the diagnosis of bile duct stones. The aim of this study was to investigate the accuracy of EUS for the diagnosis of choledocholithiasis without CBD dilatation. METHODS A total of 66 patients with suspected choledocholithiasis without CBD dilatation were enrolled. EUS were performed in all cases within 48 hours after computed tomography (CT) or ultrasonography (US). Final diagnosis was obtained by ERCP or clinical course (minimum 6 months follow-up). We analyzed the accuracy of US, CT, and EUS, respectively. RESULTS CT and US were performed in 51 and 15 cases, respectively. CBD stones were detected in 23 (35%) patients by ERCP. EUS showed 100% sensitivity, 95% specificity, 92% positive predictive value, and 100% negative predictive value for identifying CBD stones. CT or US showed 26%, 93%, 67%, and 70%, respectively. There were no EUS-related complications. CONCLUSIONS EUS was more effective than CT or US and as accurate as ERCP for the diagnosis of small choledocholithiasis without CBD dilatation. Thus, EUS may help to avoid unnecessary diagnostic ERCP and its complication.
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Affiliation(s)
- Jung Hwan Lee
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.
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Safety, feasibility, and usefulness of rectal endoscopic ultrasonography for pediatric anal and perianal complaints. J Pediatr Gastroenterol Nutr 2010; 51:93-5. [PMID: 20410843 DOI: 10.1097/mpg.0b013e3181c2c125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Mesenas S, Ang TL, Khor C, Vu C. Guidelines for Endoscopic Ultrasonography. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2010. [DOI: 10.47102/annals-acadmedsg.v39n6p489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Ainsworth AP, Hansen T, Fristrup CW, Mortensen MB. Indications for and clinical impact of repeat endoscopic ultrasound. Scand J Gastroenterol 2010; 45:477-82. [PMID: 19968612 DOI: 10.3109/00365520903453174] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The value of repeating endoscopic ultrasound (EUS) is seldom described. This study evaluates a patient population in which EUS was repeated. MATERIAL AND METHODS This was a retrospective study of patients who between January 2002 and December 2006 had an EUS scan performed; this EUS scan (re-EUS) was the second or more EUS scan performed. RESULTS Over the study period, the department performed 3024 EUS procedures, of which 561 investigations were defined as re-EUS. According to defined exclusion criteria, 244 procedures were not analyzed further. The study group thus consisted of 317 procedures (242 patients). In 163 cases (126 patients), re-EUS was planned by the endosonographer for control of an undetermined lesion. The first re-EUS scan performed changed the further management in 91 of 126 patients (72%). Sensitivity and specificity of re-EUS regarding pancreatic cancer were 0.65 and 1.00, respectively. Re-EUS was performed in 82 cases (77 patients) where no re-investigation had been planned at the initial EUS scan but worsening of symptoms or new findings of other imaging procedures had led to an additional EUS scan. Thirteen of these patients (17%) proved to have pancreatic cancer. In 62 cases (57 patients) re-EUS and EUS-guided fine-needle aspiration (FNA) had been planed in order to confirm the suspicion of malignant disease. Following re-EUS and EUS-FNA, 40 of these patients could be referred for either oncology or surgery. In the remaining 10 cases, re-EUS was performed for miscellaneous indications. CONCLUSION Re-EUS has a substantial clinical impact on the further management of the patient.
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Maple JT, Ben-Menachem T, Anderson MA, Appalaneni V, Banerjee S, Cash BD, Fisher L, Harrison ME, Fanelli RD, Fukami N, Ikenberry SO, Jain R, Khan K, Krinsky ML, Strohmeyer L, Dominitz JA. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc 2010; 71:1-9. [PMID: 20105473 DOI: 10.1016/j.gie.2009.09.041] [Citation(s) in RCA: 310] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 09/29/2009] [Indexed: 02/08/2023]
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50
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Management of antithrombotic agents for endoscopic procedures. Gastrointest Endosc 2009; 70:1060-70. [PMID: 19889407 DOI: 10.1016/j.gie.2009.09.040] [Citation(s) in RCA: 339] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 09/29/2009] [Indexed: 02/06/2023]
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