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Casey M, Tozzi F, Wang J, Park KM, Bergsland E, Hope T, Kennecke HF, Rose JB, Babicky M, Irani SS, El-Hayek KM, Hilal MA, Asbun HJ, Cleary S, Smeets P, Berrevoet F, Adam M, Rashidian N, Alseidi A, PNET Diagnosis Research Group. Appropriate use of tissue sampling and somatostatin receptor PET imaging in the diagnosis of pancreatic neuroendocrine tumors: results of an International Delphi Consensus. Surg Endosc 2025; 39:3435-3446. [PMID: 40316747 PMCID: PMC12116717 DOI: 10.1007/s00464-025-11667-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Collaborators] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Accepted: 03/10/2025] [Indexed: 05/04/2025]
Abstract
BACKGROUND Current guidelines lack clarity regarding the appropriate use of preoperative ultrasound-guided (EUS) biopsy and receptor positron emission tomography (SSTR PET) imaging for pancreatic neuroendocrine tumors (PNETs). This study aims to reach expert consensus on the optimal sequencing of SSTR PET and EUS biopsy in the diagnostic workup and management of patients with suspected PNETs. METHODS A three-round modified Delphi process was used. A multidisciplinary panel of experts was recruited via snowball sampling. A set of 22 baseline statements pertaining to diagnostic workup, imaging, and biopsy was developed based on literature review and feedback obtained through a focus group. Survey rounds were conducted electronically and anonymously. A panel of international experts was asked to indicate whether they agreed, disagreed, or lacked the appropriate background to answer each statement. Of the 55 experts invited, 38 (69%) accepted to participate. Consensus was achieved with > 80% agreement. RESULTS Response rates were 97%, 100%, and 100% in rounds 1, 2, and 3, respectively. Following rounds 1 and 2, 29 final statements achieved consensus in the following three domains: diagnostic workup (15 statements), imaging (nine statements), and tissue sampling (five statements). Cronbach's alpha value, a measure of internal consistency, was 0.91 and 0.85 for rounds 1 and 2, respectively. The final set of statements achieved a 95% approval rate in round 3. CONCLUSION This international Delphi study provides expert consensus-based guidance on the appropriate use of EUS biopsy in the diagnostic workup of PNETs in the era of SSTR PET imaging.
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Affiliation(s)
- Megan Casey
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Francesca Tozzi
- Department of General, Hepatopancreaticobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Jaeyun Wang
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Keon Min Park
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Emily Bergsland
- Department of Medicine, Division of Hematology Oncology, San Francisco (UCSF) and UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA
| | - Thomas Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | | | - J Bart Rose
- Division of Surgical Oncology, University of Alabama, Birmingham, USA
| | - Michele Babicky
- Providence Portland Medical Center, The Oregon Clinic, Portland, USA
| | - Shayan S Irani
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Centre, Seattle, USA
| | - Kevin M El-Hayek
- Department of Surgery, The MetroHealth System, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Mohammad Abu Hilal
- Department of Surgery, University of Jordan, Amman, Jordan
- Faculty of Medicine, Southampton University Hospital, Southampton, United Kingdom
| | - Horacio J Asbun
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, USA
| | - Sean Cleary
- Division of General Surgery, University of Toronto, Toronto, Canada
| | - Peter Smeets
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Frederik Berrevoet
- Department of General, Hepatopancreaticobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Mohamed Adam
- Division of Surgical Oncology, University of California San Francisco, San Francisco, USA
| | - Niki Rashidian
- Department of General, Hepatopancreaticobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Adnan Alseidi
- Division of Surgical Oncology, University of California San Francisco, San Francisco, USA.
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Collaborators
Aman Chauhan, Andrew M Bellizzi, Åsmund A Fretland, Brendan C Visser, Bryson W Katona, Daniel Halperin, Delphine L Chen, Eric Nakakura, Erik Mittra, Flavio G Rocha, Grace E Kim, Heloisa Soares, Anne Hoorens, Jess Maxwell, Jonathan M Loree, Karen Geboes, Linda Lee, Michael H Larsen, Monica Dua, Mustafa Arain, Nadine Mallak, Nancy Joseph, Nitya Raj, Pieter Hindryckx, Sun-Chuan Dai, Thorvardur R Halfdanarson, Bliede Van den Broeck,
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Santhakumar S, Deshmukh K, Mehta SS, Muthusamy RK, Venugopal J, Deepak TH, Karthi N, Sharmila S, Joseph A, Kurdula T. EBUS guided trans-esophgeal cryobiopsy-two case reports. Lung India 2025; 42:252-255. [PMID: 40296398 PMCID: PMC12097670 DOI: 10.4103/lungindia.lungindia_531_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 05/20/2024] [Accepted: 10/21/2024] [Indexed: 04/30/2025] Open
Abstract
ABSTRACT Endobronchial ultrasound (EBUS) guided mediastinal cryobiopsy is a novel technique which can be combined with EBUS -TBNA to improve the diagnostic yield. Recent studies report, this technique is safe and superior to EBUS TBNA alone in terms of acquisition of larger tissue samples and thereby a better diagnostic yield and adequacy of tissue for molecular studies. However, safety of this technique in patients do not tolerate a bronchoscopic procedure due to hypoxia or respiratory distress is not clarified yet. Alternatively, EBUS guided FNA via trans-esophageal route(EUS-B-FNA) is a proven technique with a similar diagnostic yield as EBUS TBNA with a better tolerance and a more patient comfort. We report two patients here, in whom EUS- B guided cryobiopsy was successfully done via trans-esophageal route, due to intolerance for bronchoscopic procedure and inconclusive ROSE reports.
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Affiliation(s)
- S. Santhakumar
- Department of Pulmonology, KMCH, Coimbatore, Tamil Nadu, India
| | - Karan Deshmukh
- Department of Pulmonology, KMCH, Coimbatore, Tamil Nadu, India
| | | | | | - J. Venugopal
- Department of Pulmonology, KMCH, Coimbatore, Tamil Nadu, India
| | - T. H Deepak
- Department of Pulmonology, KMCH, Coimbatore, Tamil Nadu, India
| | - N. Karthi
- Department of Anesthesia, KMCH, Coimbatore, Tamil Nadu, India
| | - S Sharmila
- Department of Anesthesia, KMCH, Coimbatore, Tamil Nadu, India
| | - Ananthu Joseph
- Department of Pulmonology, KMCH, Coimbatore, Tamil Nadu, India
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Lee BK, Kwan BS, Kim KM, Shim SG, Lee JW, Kim JY, Sung BR, Kim HI, Kim SH. Safety of early feeding after endoscopic ultrasound-guided fine needle biopsy: a retrospective study. BMC Gastroenterol 2025; 25:289. [PMID: 40269755 PMCID: PMC12020099 DOI: 10.1186/s12876-025-03893-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2025] [Accepted: 04/14/2025] [Indexed: 04/25/2025] Open
Abstract
BACKGROUND Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) is a widely utilized and relatively safe procedure for diagnosing pancreatic diseases. Although early feeding post-EUS-FNB is clinically advantageous, consensus regarding the optimal feeding time in current guidelines remains lacking. Therefore, this study aims to evaluate the efficacy and safety of early feeding after EUS-FNB. METHODS A retrospective analysis was conducted on 111 patients who underwent EUS-FNB for diagnosing pancreatic diseases between January 1, 2021, and March 31, 2022, at Samsung Changwon Hospital. Patients were divided into two groups: those who fed within 4 h after the procedure and those who remained fasting for 24 h after the procedure. We investigated two hospitalization duration metrics: procedure-related hospital days (HD), defined as the period exclusively attributed to EUS-FNB recovery, and total HD, encompassing the entire hospitalization duration, including additional diagnostic or therapeutic interventions unrelated to the procedure. RESULTS After excluding missing data, 110 patients were analyzed. Among them, the mean age was 67.4 years, with 52.7% being male. Of these, 42 patients resumed early feeding. No significant difference was observed between the two groups in terms of complications. However, the procedure-related HD was shorter in the early feeding group (3.8 ± 0.8 vs. 4.9 ± 0.7 days, P = 0.001). Additionally, the multivariate analysis revealed no difference in complication rates between the two groups (odds ratio; 0.83, 95% confidence interval; 0.07-9.39, P = 0.877). CONCLUSIONS Early feeding following EUS-FNB was associated with a shorter hospitalization stay without increasing the risk of complications. These findings suggest that early feeding after EUS-FNB offers clinical benefits.
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Affiliation(s)
- Bo Kyeong Lee
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158, Paryong-ro, Masanhoewon-gu, Changwon-si, Gyeongsangnam-do, Republic of Korea
| | - Byung Soo Kwan
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158, Paryong-ro, Masanhoewon-gu, Changwon-si, Gyeongsangnam-do, Republic of Korea.
| | - Kwang Min Kim
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158, Paryong-ro, Masanhoewon-gu, Changwon-si, Gyeongsangnam-do, Republic of Korea
| | - Sang Goon Shim
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158, Paryong-ro, Masanhoewon-gu, Changwon-si, Gyeongsangnam-do, Republic of Korea
| | - Jung Won Lee
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158, Paryong-ro, Masanhoewon-gu, Changwon-si, Gyeongsangnam-do, Republic of Korea
| | - Jun Young Kim
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158, Paryong-ro, Masanhoewon-gu, Changwon-si, Gyeongsangnam-do, Republic of Korea
| | - Bo Ram Sung
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158, Paryong-ro, Masanhoewon-gu, Changwon-si, Gyeongsangnam-do, Republic of Korea
| | - Hye In Kim
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158, Paryong-ro, Masanhoewon-gu, Changwon-si, Gyeongsangnam-do, Republic of Korea
| | - Seung Hwan Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
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Chen H, Jing X. Individualized treatment guided by endoscopic ultrasound-guided fine-needle aspiration for adrenocortical oncocytoma: A case report. World J Clin Oncol 2025; 16:98223. [PMID: 39995551 PMCID: PMC11686559 DOI: 10.5306/wjco.v16.i2.98223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 10/01/2024] [Accepted: 11/12/2024] [Indexed: 12/11/2024] Open
Abstract
BACKGROUND Adrenocortical oncocytoma is a rare, mostly benign, nonfunctional tumor that is typically detected incidentally. Its diagnosis is challenging because of the absence of distinctive imaging characteristics, necessitating pathological validation. CASE SUMMARY We present a case report of a 35-year-old woman with an adrenal mass located on the left side, where endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed after comprehensive diagnostic assessment. Our results are consistent with those of previously documented cases regarding tumor demographics and anatomical location. Given the limited number of reports on this condition, long-term follow-up is crucial to enhance our understanding of its prognosis. CONCLUSION For patients with adrenocortical oncocytoma, EUS-FNA can enables collection of preoperative tissue specimens leading to suitable treatment strategies.
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Affiliation(s)
- Han Chen
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Xue Jing
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
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Okasha H, Gadour E, Tayyab GUN, Seicean A, Hicham E, Emad E, Alamri T, Tehami N, Faraj HI, Alzamzamy A, Hussein H, Tag-Adeen M, Elbasiony M, Al-Lehibi A, Saleh S, Houmani Z, Abdelghani M, Ragab K, Ismaili Z, Drir O, Ghoneem E, Abdallah O, Rebiai S, Pausawasdi N, Rouibaa F, Borahma M, Atalla H, Farouk M, Altonbary A. Comprehensive analysis of endoscopic ultrasound (EUS) in mediastinal lesions: patient characteristics, diagnostic outcomes, safety, and efficacy: a multi-country study. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2025; 37:25. [DOI: 10.1186/s43162-025-00409-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 01/31/2025] [Indexed: 02/10/2025] Open
Abstract
Abstract
Background
Mediastinal lesions are tumors that develop mainly from structures commonly located in the three compartments of the mediastinum and the paravertebral areas. The diagnosis of these lesions is primarily based on imaging studies such as computed tomography and magnetic resonance imaging, which confirm the presence of the lesions and suspected metastatic disease. The study aims to determine the factors that determine the diagnostic accuracy and yield of endoscopic ultrasound (EUS) in diagnosing mediastinal lesions.
Methods
This multi-country study involved a list of centers providing EUS services across ten countries—the United Kingdom, Algeria, Egypt, Iraq, Kingdom of Saudi Arabia (KSA), Lebanon, Morocco, Pakistan, Romania, and Thailand. The appropriate information was collected regarding EUS-FNA and EUS-FNB procedures, including needle types, nature of lesion, needle passes, and complications of the techniques. The frequency/percentage conveyed data on the qualitative variables. The p-values were obtained using the Chi-square two-tailed exact test. The significance of the analysis was defined as p < 0.05. All the syntheses were performed using the Statistical Package for the Social Sciences (SPSS version 27; SPSS Inc., Chicago, IL, USA).
Results
A total of 439 participants were involved in this study, 255 (58.1%) males and 184 (41.9%) females, with a mean age of 55.73
$$\pm$$
±
14.93 years. EUS-FNA and EUS-FNB diagnostic yield was influenced by needle types, needle size, number of needle passes, and lesion size. Among females, 44.6% were diagnosed with EUS-FNA, 42.8% with EUS-FNB, and 50.0% with EUS-FNA and FNB. Conversely, 55.4% of males were diagnosed using EUS-FNA and 57.2% with EUS-FNB. The association between gender and the diagnostic method, however, was statistically insignificant (p = 0.197). Needles with smaller diameters (22G) offered greater diagnostic yield than needles with larger diameters (19G). A minimal number of needle passes (between 2 and 4) showed a higher diagnostic yield than a higher number of needle passes (> 5). EUS-FNB accounted for a 0.5% complication incidence rate each for fever, pain, thoracic pain, and hemorrhage. EUS-FNA had no complication rate. Patients undergoing EUS-FNA, EUS-FNB, or both procedural examinations had no significant complications (p = 0.085).
Conclusion
The diagnostic yield of EUS procedures is affected by needle types, number of needle passes, lesion size, and needle size. Besides, EUS-FNA and EUS-FNB are infrequently associated with various complication rates. These techniques are safe and offer higher diagnostic yield when utilized responsibly by endosonographers.
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Kleemann T, Freund R, Braden B, Hocke M, Hollerbach S, Jenssen C, Möller K, Dong Y, Bhutani MS, Kitano M, Sun S, El-Lehibi A, Dietrich CF. An international survey on the geographical differences in practice patterns and training of endoscopic ultrasound. J Transl Int Med 2025; 13:48-64. [PMID: 40115033 PMCID: PMC11921813 DOI: 10.1515/jtim-2025-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2025] Open
Abstract
BACKGROUND AND OBJECTIVES Recently, a series of publications discuss what kind of clinical and technical information is important to know before performing endoscopic ultrasound (EUS) examinations. This paper aims to investigate variations in the performance of EUS examinations in different countries worldwide to present views and experiences on the use of pre-EUS investigations. METHODS In a multinational and multidisciplinary survey, more than 100 practicing EUS endoscopists were surveyed by a questionnaire asking for their level of education and training, their experience in diagnostic and therapeutic procedures, preferred technical use and procedural steps before EUS examination. Substantial geographic variation not only in the level of training and mandatory imaging prior to EUS, but consequently also in the standards and practice of EUS examinations and advanced EUS guided therapeutic procedures were observed. The participants' preferences regarding technical use and procedural steps prior to EUS examinations were assessed according to their level of education and training experience. RESULTS Transabdominal ultrasound (TUS) is performed prior to EUS by the EUS endoscopists themselves in most European countries but not in North and South Americas where non-invasive pre-EUS imaging is delegated to other specialties such as radiology. Different training backgrounds, cultural beliefs, infrastructures, available equipment and access to training programs have a strong impact on the EUS workforce and EUS procedural practice across the continents. CONCLUSIONS The study results suggest existence of relevant geographical differences that reflect not only the different levels of education in different settings but also differences regarding technical standards for the performance of EUS and TUS examinations worldwide.
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Affiliation(s)
- Tobias Kleemann
- Department of Gastroenterology and Rheumatology, Carl-Thiem-Hospital Cottbus, Cottbus03048, Germany
| | - Robert Freund
- Thiem Research, Carl-Thiem-Hospital Cottbus, Cottbus03048, Germany
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, OxfordOX3 9DU, UK
- Medical Department B, University of Muenster, Muenster48149, Germany
| | - Michael Hocke
- Department of Internal Medicine II, Helios Hospital Meiningen, Meiningen98617, Germany
| | - Stephan Hollerbach
- Department of Medicine and Gastroenterology, Allgemeines Krankenhaus, Celle29223, Germany
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg15344, Germany
- Brandenburg Institute for Clinical Ultrasound, Medical University Brandenburg, Neuruppin16816, Germany
| | - Kathleen Möller
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin10365, Germany
| | - Yi Dong
- Department of Ultrasound, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Manoop Singh Bhutani
- Department of Gastroenterology, Hepatology, Nutrition, UT MD Anderson Cancer Center, Houston, TX77030, USA
| | - Masayuki Kitano
- Department of Internal Medicine, Wakayama Medical University, Wakayama641-0012, Japan
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang110004, Liaoning Province, China
| | - Abed El-Lehibi
- Gastroenterology & Hepatology Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Christoph Frank Dietrich
- Department of Internal Medicine, Clinics Beau-Site, Salem, and Permanence, Bern3013, Switzerland
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Rodrigues JO, Matos P, Rodrigues LV, de Santis M, Barradas L. Iatrogenic intramural esophageal hematoma during EUS-B-FNA procedure. BMC Pulm Med 2025; 25:10. [PMID: 39780105 PMCID: PMC11715552 DOI: 10.1186/s12890-024-03470-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/30/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND Esophageal ultrasound with bronchoscope fine needle aspiration (EUS-B-FNA) is a valuable tool for the diagnosis and staging of lung cancer, complementing endobronchial lung ultrasound (EBUS). While generally considered safe, there is a notable lack of comprehensive knowledge within the interventional pulmonology community regarding potential complications. CASE PRESENTATION We present a case involving a 66-year-old male with squamous cell lung carcinoma undergoing mediastinal staging. A systematic mediastinal assessment through EBUS confirmed the presence of enlarged lymph nodes at 4 L with limited access to puncture. Complementary EUS-B widened the visualization and access to station 4 L and after excluding nearby vessels, a single puncture was performed. Unexpectedly, an iatrogenic esophageal hematoma was promptly noted at the puncture site. The procedure was immediately interrupted, and subsequent workup confirmed the hematoma without active bleeding. Conservative management, including upper endoscopy and clip sealing, resulted in the patient's asymptomatic recovery. CONCLUSION This case underscores the importance of recognizing and managing complications associated with EUS-B-FNA, emphasizing the need for heightened awareness and education in the interventional pulmonology community. Despite being infrequently discussed in medical literature, EUS-B-FNA can give rise to both immediate and delayed complications, warranting increased vigilance during its practice.
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Affiliation(s)
- João Oliveira Rodrigues
- Hospital Santa Marta - Unidade Local de Saúde de São José, Rua de Santa Marta 50, Lisboa, 1169-024, Portugal.
| | - Paulo Matos
- Unidade de Broncologia e Pneumologia de Intervenção - Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal
| | - Luís Vaz Rodrigues
- Unidade de Broncologia e Pneumologia de Intervenção - Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Michele de Santis
- Unidade de Broncologia e Pneumologia de Intervenção - Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal
| | - Lourdes Barradas
- Unidade de Broncologia e Pneumologia de Intervenção - Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal
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Zhang Y, Li N, Yu L. Ultrasound-Guided Needle Aspiration and Antibiotic Injection for Subperiosteal Orbital Abscess: A Case Study and 3-Year Follow-Up. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e944844. [PMID: 39533671 PMCID: PMC11591368 DOI: 10.12659/ajcr.944844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 09/25/2024] [Accepted: 09/11/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Orbital abscess is a severe infectious condition of the eye that can result in significant complications, including vision loss or fatality. Timely and accurate diagnosis and treatment of this condition are crucial. CASE REPORT A 45-year-old man with exophthalmos, diplopia, and decreased vision was admitted to our hospital. He had a history of chronic sinusitis. Ultrasonography showed a dark fluid area above the superior rectus muscle of the right eye, measuring approximately 5.7 ml. Orbital MRI revealed short T1 and long T2 signal shadows outside the upper muscle cone of the right orbit, with a size of about 13.2 ml. The right eyeball was compressed and moved forward, and the superior rectus muscle was also compressed. Long T2 signal shadows were observed in the right frontal sinus, maxillary sinus, and bilateral ethmoid sinuses, leading to a diagnosis of orbital subperiosteal abscess and sinusitis. We performed a fine-needle puncture and injection of antibiotics into the abscess cavity using a 5-ml syringe under the guidance of B-ultrasound. On the 7th day after surgery, the patient showed clinical improvement with decreased symptoms. His visual acuity improved from 20/40 to 20/20, and diplopia resolved. His sinusitis was treated with medication, and no recurrence of ocular symptoms was observed during the 3-year follow-up. CONCLUSIONS This report highlights the use of ultrasound-guided fine-needle puncture and injection of antibiotics into the abscess cavity for the treatment of an upper-quadrant orbital subperiosteal abscess. Timely surgical drainage and effective antibiotic therapy can help reduce the complications associated with orbital abscesses.
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Affiliation(s)
| | | | - Lei Yu
- Corresponding Author: Lei Yu, e-mail:
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Franzén B, Auer G, Lewensohn R. Minimally invasive biopsy-based diagnostics in support of precision cancer medicine. Mol Oncol 2024; 18:2612-2628. [PMID: 38519839 PMCID: PMC11547246 DOI: 10.1002/1878-0261.13640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/31/2024] [Accepted: 03/14/2024] [Indexed: 03/25/2024] Open
Abstract
Precision cancer medicine (PCM) to support the treatment of solid tumors requires minimally invasive diagnostics. Here, we describe the development of fine-needle aspiration biopsy-based (FNA) molecular cytology which will be increasingly important in diagnostics and adaptive treatment. We provide support for FNA-based molecular cytology having a significant potential to replace core needle biopsy (CNB) as a patient-friendly potent technique for tumor sampling for various tumor types. This is not only because CNB is a more traumatic procedure and may be associated with more complications compared to FNA-based sampling, but also due to the recently developed molecular methods used with FNA. Recent studies show that image-guided FNA in combination with ultrasensitive molecular methods also offers opportunities for characterization of the tumor microenvironment which can aid therapeutic decisions. Here we provide arguments for an increased implementation of molecular FNA-based sampling as a patient-friendly diagnostic method, which may, due to its repeatability, facilitate regular sampling that is needed during different treatment lines, to provide tumor information, supporting treatment decisions, shortening lead times in healthcare, and benefit healthcare economics.
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Affiliation(s)
- Bo Franzén
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Cancer Centre Karolinska (CCK) FoundationKarolinska University HospitalStockholmSweden
| | - Gert Auer
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
| | - Rolf Lewensohn
- Department of Oncology‐PathologyKarolinska InstitutetStockholmSweden
- Theme Cancer, Medical Unit Head and Neck, Lung, and Skin Tumors, Thoracic Oncology CenterKarolinska University HospitalStockholmSweden
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Soltani A, Salimi M, Nemati M, Mirshamsi A. Recurrent gastric intramural pseudocyst: A case report and comprehensive literature review of reported cases. Radiol Case Rep 2024; 19:5429-5441. [PMID: 39285981 PMCID: PMC11403908 DOI: 10.1016/j.radcr.2024.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 08/07/2024] [Accepted: 08/10/2024] [Indexed: 09/19/2024] Open
Abstract
Intramural gastric pseudocysts are extremely rare and are often associated with pancreatitis and pancreatic pseudocysts; they can lead to complex clinical presentations requiring careful diagnosis and management. We present a case of a 57-year-old man with a history of pancreatitis and pancreatic pseudocysts who was diagnosed with intramural gastric pseudocysts. The patient was diagnosed with multiple gastric intramural pseudocysts at different locations during separate admissions and imaging studies. This indicates a recurrence of gastric intramural pseudocysts. In these cases, studies rarely discuss recurrence and its underlying causes. This highlights a significant gap in the existing literature. To provide a broader understanding, we reviewed the literature by searching major databases (PubMed, Scopus, and Web of Science) and then extracted and analyzed data from 18 articles, reaching 24 similar cases. Of the 25 patients studied (including our case), 92% were male and 8% were female. Cases had a mean age of 47.68 ± 14.82 years. Additionally, 84% of the patients had a history of alcohol consumption, and 88% had a positive history of pancreatitis. Common symptoms were abdominal pain (especially in the epigastric region), vomiting, nausea, and weight loss. In conclusion, results showed that intramural gastric pseudocysts generally occur in middle-aged men with a history of chronic or heavy alcohol consumption and pancreatitis.
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Affiliation(s)
- Amirhossein Soltani
- Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Salimi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Nemati
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Mirshamsi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Fantin A, Castaldo N, Crisafulli E, Sartori G, Villa A, Felici E, Kette S, Patrucco F, van der Heijden EHFM, Vailati P, Morana G, Patruno V. Minimally Invasive Sampling of Mediastinal Lesions. Life (Basel) 2024; 14:1291. [PMID: 39459591 PMCID: PMC11509195 DOI: 10.3390/life14101291] [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: 07/17/2024] [Revised: 09/03/2024] [Accepted: 10/07/2024] [Indexed: 10/28/2024] Open
Abstract
This narrative review examines the existing literature on minimally invasive image-guided sampling techniques of mediastinal lesions gathered from international databases (Medline, PubMed, Scopus, and Google Scholar). Original studies, systematic reviews with meta-analyses, randomized controlled trials, and case reports published between January 2009 and November 2023 were included. Four authors independently conducted the search to minimize bias, removed duplicates, and selected and evaluated the studies. The review focuses on the recent advancements in mediastinal sampling techniques, including EBUS-TBNA, EUS-FNA and FNB, IFB, and nodal cryobiopsy. The review highlights the advantages of an integrated approach using these techniques for diagnosing and staging mediastinal diseases, which, when used competently, significantly increase diagnostic yield and accuracy.
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Affiliation(s)
- Alberto Fantin
- Department of Pulmonology, S. Maria della Misericordia University Hospital, 33100 Udine, Italy
- Department of Medicine, Respiratory Medicine Unit, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, 37134 Verona, Italy
| | - Nadia Castaldo
- Department of Pulmonology, S. Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Ernesto Crisafulli
- Department of Medicine, Respiratory Medicine Unit, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, 37134 Verona, Italy
| | - Giulia Sartori
- Department of Medicine, Respiratory Medicine Unit, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, 37134 Verona, Italy
| | - Alice Villa
- Department of Medicine, Respiratory Medicine Unit, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, 37134 Verona, Italy
| | - Elide Felici
- Department of Medicine, Respiratory Medicine Unit, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, 37134 Verona, Italy
| | - Stefano Kette
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Filippo Patrucco
- Division of Respiratory Diseases, Department of Medicine, Maggiore della Carità University Hospital, 28100 Novara, Italy
| | | | - Paolo Vailati
- Department of Pulmonology, S. Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Giuseppe Morana
- Department of Pulmonology, S. Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Vincenzo Patruno
- Department of Pulmonology, S. Maria della Misericordia University Hospital, 33100 Udine, Italy
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12
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Jiang H, Ye LS, Yuan XL, Luo Q, Zhou NY, Hu B. Artificial intelligence in pancreaticobiliary endoscopy: Current applications and future directions. J Dig Dis 2024; 25:564-572. [PMID: 39740251 DOI: 10.1111/1751-2980.13324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2024] [Revised: 11/13/2024] [Accepted: 12/03/2024] [Indexed: 01/02/2025]
Abstract
Pancreaticobiliary endoscopy is an essential tool for diagnosing and treating pancreaticobiliary diseases. However, it does not fully meet clinical needs, which presents challenges such as significant difficulty in operation and risks of missed diagnosis or misdiagnosis. In recent years, artificial intelligence (AI) has enhanced the diagnostic and treatment efficiency and quality of pancreaticobiliary endoscopy. Diagnosis and differential diagnosis based on endoscopic ultrasound (EUS) images, pathology of EUS-guided fine-needle aspiration or biopsy, need for endoscopic retrograde cholangiopancreatography (ERCP) and assessment of operational difficulty, postoperative complications and prediction of patient prognosis, and real-time procedure guidance. This review provides an overview of AI applications in pancreaticobiliary endoscopy and proposes future development directions in aspects such as data quality and algorithmic interpretability, aiming to provide new insights for the integration of AI technology with pancreaticobiliary endoscopy.
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Affiliation(s)
- Huan Jiang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Digestive Endoscopy Medical Engineering Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Lian Song Ye
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Digestive Endoscopy Medical Engineering Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiang Lei Yuan
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Digestive Endoscopy Medical Engineering Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Qi Luo
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Digestive Endoscopy Medical Engineering Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Nuo Ya Zhou
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Digestive Endoscopy Medical Engineering Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Bing Hu
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
- Med-X Center for Materials, Sichuan University, Chengdu, Sichuan Province, China
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13
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Rogowska J, Semeradt J, Durko Ł, Małecka-Wojciesko E. Diagnostics and Management of Pancreatic Cystic Lesions-New Techniques and Guidelines. J Clin Med 2024; 13:4644. [PMID: 39200786 PMCID: PMC11355509 DOI: 10.3390/jcm13164644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/01/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Pancreatic cystic lesions (PCLs) are increasingly diagnosed owing to the wide use of cross-sectional imaging techniques. Accurate identification of PCL categories is critical for determining the indications for surgical intervention or surveillance. The classification and management of PCLs rely on a comprehensive and interdisciplinary evaluation, integrating clinical data, imaging findings, and cyst fluid markers. EUS (endoscopic ultrasound) has become the widely used diagnostic tool for the differentiation of pancreatic cystic lesions, offering detailed evaluation of even small pancreatic lesions with high sensitivity and specificity. Additionally, endoscopic ultrasound-fine-needle aspiration enhances diagnostic capabilities through cytological analysis and the assessment of fluid viscosity, tumor glycoprotein concentration, amylase levels, and molecular scrutiny. These detailed insights play a pivotal role in improving the clinical prognosis and management of pancreatic neoplasms. This review will focus mainly on the latest recommendations for the differentiation, management, and treatment of pancreatic cystic lesions, highlighting their clinical significance.
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Affiliation(s)
- Jagoda Rogowska
- Department of Digestive Tract Diseases, Medical University of Lodz, 90-647 Lodz, Poland; (J.S.); (Ł.D.); (E.M.-W.)
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14
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Raghareutai K, Yingyongthawat W, Pausawasdi N. Choosing needles wisely: 19-G conventional vs. Franseen needles in endoscopic ultrasound-guided fine-needle aspiration for malignant lymphoma diagnosis and classification. Clin Endosc 2024; 57:473-475. [PMID: 39075975 PMCID: PMC11294864 DOI: 10.5946/ce.2024.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/30/2024] [Accepted: 07/01/2024] [Indexed: 07/31/2024] Open
Affiliation(s)
- Kajornvit Raghareutai
- Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Division of Gastroenterology, Department of Medicine, Karnchanapisek Campus, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Worapoth Yingyongthawat
- Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nonthalee Pausawasdi
- Siriraj GI Endoscopy Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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15
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Möller K, Löwe A, Jenssen C, Bhutani MS, On W, Everett SM, Braden B, Hocke M, Healey A, Dong Y, Gerber M, Faiss S, Rimbas M, Ge N, Sun S, Taut H, Srivastava D, Burmester E, Dietrich CF. Comments and illustrations of the European Federation of Societies for Ultrasound in Medicine contrast-enhanced ultrasound guidelines. Rare pancreatic tumors, imaging features on transabdominal ultrasound and EUS with contrast enhancement: Rare epithelial pancreatic tumors: solid pseudopapillary neoplasm, acinar cell carcinoma, mixed neuroendocrine-non-neuroendocrine neoplasms, some rare subtypes of pancreatic adenocarcinoma and pancreatoblastoma. Endosc Ultrasound 2024; 13:129-144. [PMID: 39318646 PMCID: PMC11419495 DOI: 10.1097/eus.0000000000000056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/13/2023] [Indexed: 09/26/2024] Open
Abstract
Rare malignant pancreatic lesions are systematically reported in this review. The focus is on the imaging appearance of the rare epithelial pancreatic tumors such as the solid pseudopapillary neoplasm, acinar cell carcinoma, rare subtypes of adenocarcinoma, and pancreatoblastoma as seen on ultrasound, EUS, and contrast-enhanced ultrasound or EUS. The present overview summarizes the data and shows that not every pancreatic tumor is likely to be the most common entities of ductal adenocarcinoma or neuroendocrine tumor.
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Affiliation(s)
- Kathleen Möller
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin, Germany
| | - Axel Löwe
- Department Allgemeine Innere Medizin der Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch-Oderland, Strausberg, Germany
- Brandenburg Institute for Clinical Ultrasound (BICUS) at Medical University Brandenburg, Neuruppin, Germany
| | - Manoop S. Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Wei On
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Simon M. Everett
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, United Kingdom
| | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Germany
| | - Andrew Healey
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Michael Gerber
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin, Germany
| | - Siegbert Faiss
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin, Germany
| | - Mihai Rimbas
- Department of Gastroenterology, Clinic of Internal Medicine, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania
| | - Nan Ge
- Department of Endoscopy Center, Shengjing Hospital of China Medical University, Liaoning Province, China
| | - Siyu Sun
- Department of Endoscopy Center, Shengjing Hospital of China Medical University, Liaoning Province, China
| | - Heike Taut
- Children's Hospital, Universitätsklinikum Dresden, Technische Universität Dresden, Dresden, Germany
| | - David Srivastava
- Department Allgemeine Innere Medizin der Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
- University Hospital, Inselspital Bern, Switzerland
| | - Eike Burmester
- Medizinische Klinik I, Sana Kliniken Luebeck, Lübeck, Germany
| | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin der Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
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16
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Boicean A, Prisca D, Bratu DG, Bacila CI, Tanasescu C, Chicea R, Fleaca SR, Birsan SA, Ichim C, Mohor CI, Roman MD, Cristian AN, Todor SB, Mohor CI, Moisin A, Hasegan A. Uncommon Presentation of Gastric Duplication Cyst with Left-Sided Portal Hypertension: A Case Report and Literature Review. Diagnostics (Basel) 2024; 14:675. [PMID: 38611587 PMCID: PMC11011661 DOI: 10.3390/diagnostics14070675] [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: 02/12/2024] [Revised: 03/14/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Gastric duplication cysts (GDCs) in adults are exceedingly rare, with only a few documented cases in medical literature. The spectrum of clinical presentations varies widely, ranging from asymptomatic to severe symptoms such as hematemesis, vomiting or abdominal pain. Among the less common complications associated with GDCs, segmental portal hypertension is a notable rarity. We present a compelling case report of a patient exhibiting signs of segmental portal hypertension, where ultrasound and echo-endoscopy revealed a sizable gastric duplication cyst as the underlying etiology. Recognizing the scarcity of literature on GDCs in adult patients, we conducted a thorough review to underscore the diagnostic significance of ultrasonography and endoscopic ultrasound (EUS) in accurately identifying these congenital anomalies. This case report and comprehensive literature review emphasize the pivotal role of EUS and abdominal ultrasound in achieving an accurate diagnosis of GDCs. By shedding light on the diagnostic and therapeutic intricacies, we aim to raise awareness among clinicians regarding this rare pathology and the importance of multimodal imaging approaches for optimal patient management.
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Affiliation(s)
- Adrian Boicean
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Diana Prisca
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania;
| | - Dan Georgian Bratu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Ciprian Ionut Bacila
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Ciprian Tanasescu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Radu Chicea
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Sorin Radu Fleaca
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Sabrina Andreea Birsan
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Cristian Ichim
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Calin Ilie Mohor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Mihai Dan Roman
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Adrian Nicolae Cristian
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Samuel Bogdan Todor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Cosmin Ioan Mohor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Andrei Moisin
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Adrian Hasegan
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
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17
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Yao L, Amar H, Aroori S. Incidental double duct sign: Should we be worried? Results from a long-term follow-up study. Ann Hepatobiliary Pancreat Surg 2024; 28:53-58. [PMID: 37914668 PMCID: PMC10896684 DOI: 10.14701/ahbps.23-063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/21/2023] [Accepted: 07/05/2023] [Indexed: 11/03/2023] Open
Abstract
Backgrounds/Aims Double duct sign (DDS) (dilated common bile and pancreatic duct) is synonymous with pancreatic head/peri-ampullary tumor (PHPAT). There is limited evidence on whether incidental DDS (I-DDS) is associated with an increased risk of malignancy. This study aimed to evaluate 5-year outcomes of I-DDS. Methods Patients were categorized according to their risk of malignancy. 'Low-risk' patients, including those with I-DDS between 2010 and 2015, were analyzed in this study. The primary outcome was incidence of PHPAT within five years of identification of DDS. Histology results from endoscopic ultrasound-guided biopsy were considered diagnostic. Secondary outcomes were incidence of benign causes, extent of follow-up investigations, and clinical indicators of malignancy in patients with DDS. Results Among 103 patients with DDS, 20 had I-DDS. Subsequent follow-up of these 20 patients found no patient with PHPAT, two (10%) patients with chronic pancreatitis, and 18 (90%) patients with no cause found. The median follow-up duration for 'low-risk' patients was 7.3 years (range, 6-11 years). The mean number of follow-up investigations per patient was two (range, 0-9). Investigations included computed tomography (n = 27), magnetic resonance cholangiopancreatography (n = 23), endoscopy (n = 16), and ultrasound (n = 14). Patients with jaundice were more likely to have malignancy (p < 0.01). Those with abdominal pain were more likely to have a benign cause (p < 0.01). Hyperbilirubinemia and/or deranged liver enzymes and raised CA19-9 were more likely to be associated with PHPAT (p < 0.01). Conclusions Patients with I-DDS have a low risk of developing PHPAT within five years.
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Affiliation(s)
- Lu Yao
- Department of HPB Surgery, University of Plymouth, Plymouth, UK
| | - Hoda Amar
- Department of HPB Surgery, University of Plymouth, Plymouth, UK
| | - Somaiah Aroori
- Department of HPB Surgery, University of Plymouth, Plymouth, UK
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18
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de Jong M, van Delft F, Roozen C, van Geenen EJ, Bisseling T, Siersema P, Bruno M. Nonsteroidal anti-inflammatory drugs before endoscopic ultrasound guided tissue acquisition to reduce the incidence of post procedural pancreatitis. World J Gastroenterol 2024; 30:811-816. [PMID: 38516233 PMCID: PMC10950633 DOI: 10.3748/wjg.v30.i8.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/22/2023] [Accepted: 01/22/2024] [Indexed: 02/26/2024] Open
Abstract
Endoscopic ultrasound (EUS) with fine needle aspiration or fine needle biopsy is the gold standard for sampling tissue to diagnose pancreatic cancer and autoimmune pancreatitis or to analyze cyst fluid. The most common reported adverse event of fine needle aspiration and/or fine needle biopsy is acute pancreatitis, which is likely induced by the same pathophysiological mechanisms as after endoscopic retrograde cholangiopancreatography (ERCP). According to the current European Society of Gastrointestinal Endoscopy guideline, nonsteroidal anti-inflammatory drugs are administered prior to ERCP as a scientifically proven treatment to reduce post-ERCP pancreatitis incidence rate. A single suppository of diclofenac or indomethacin prior to EUS guided tissue acquisition (TA) is harmless in healthy adults. Since it is associated with low costs and, most important, may prevent a dreadsome complication, we strongly recommend the administration of 100 mg diclofenac rectally prior to EUS-TA. We will explain this recommendation in more detail in this review as well as the risk and pathophysiology of post-EUS TA pancreatitis.
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Affiliation(s)
- Mike de Jong
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen 6525 GA, Netherlands
| | - Foke van Delft
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen 6525 GA, Netherlands
| | - Christine Roozen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen 6525 GA, Netherlands
| | - Erwin-Jan van Geenen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen 6525 GA, Netherlands
| | - Tanya Bisseling
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen 6525 GA, Netherlands
| | - Peter Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen 6525 GA, Netherlands
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam 3015 GD, Netherlands
| | - Marco Bruno
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam 3015 GD, Netherlands
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Chen X, Zhou J, Wang P, Wang P, Wang L, Mu L, Lang C, Mu Y, Wang X, Shang R, Li Q, Lv H, Wu K, Shi N, Jia X, Lai Y, Zhang Y, Li Z, Zhong N. Endoscopic ultrasound-based application system for predicting endoscopic resection-related outcomes and diagnosing subepithelial lesions: Multicenter prospective study. Dig Endosc 2024; 36:141-151. [PMID: 37059698 DOI: 10.1111/den.14568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/13/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVES Subepithelial lesions (SELs) are associated with various endoscopic resection (ER) outcomes and diagnostic challenges. We aimed to establish a tool for predicting ER-related outcomes and diagnosing SELs and to investigate the predictive value of endoscopic ultrasound (EUS). METHODS Phase 1 (system development) was performed in a retrospective cohort (n = 837) who underwent EUS before ER for SELs at eight hospitals. Prediction models for five key outcomes were developed using logistic regression. Models with satisfactory internal validation performance were included in a mobile application system, SEL endoscopic resection predictor (SELERP). In Phase 2, the models were externally validated in a prospective cohort of 200 patients. RESULTS An SELERP was developed using EUS characteristics, which included 10 models for five key outcomes: post-ER ulcer management, short procedure time, long hospital stay, high medication costs, and diagnosis of SELs. In Phase 1, 10 models were derived and validated (C-statistics, 0.67-0.99; calibration-in-the-large, -0.14-0.10; calibration slopes, 0.92-1.08). In Phase 2, the derived risk prediction models showed convincing discrimination (C-statistics, 0.64-0.73) and calibration (calibration-in-the-large, -0.02-0.05; calibration slopes, 1.01-1.09) in the prospective cohort. The sensitivities and specificities of the five diagnostic models were 68.3-95.7% and 64.1-83.3%, respectively. CONCLUSION We developed and prospectively validated an application system for the prediction of ER outcomes and diagnosis of SELs, which could aid clinical decision-making and facilitate patient-physician consultation. EUS features significantly contributed to the prediction. TRIAL REGISTRATION Chinese Clinical Trial Registry, http://www.chictr.org.cn (ChiCTR2000040118).
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Affiliation(s)
- Xinyu Chen
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Digestive Disease, Qilu Hospital of Shandong University, Jinan, China
| | - Jiawei Zhou
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Digestive Disease, Qilu Hospital of Shandong University, Jinan, China
| | - Peizhu Wang
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Digestive Disease, Qilu Hospital of Shandong University, Jinan, China
| | - Peng Wang
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
| | - Limei Wang
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
| | - Linjun Mu
- Department of Gastroenterology, Weifang People's Hospital, Weifang, China
| | - Cuicui Lang
- Department of Gastroenterology, Liaocheng People's Hospital, Liaocheng, China
| | - Ying Mu
- Department of Gastroenterology, Liaocheng People's Hospital, Liaocheng, China
| | - Xiaohong Wang
- Department of Gastroenterology, The Affiliated Taian City Centeral Hospital of Qingdao University, Taian, China
| | - Ruilian Shang
- Department of Gastroenterology, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Qun Li
- Department of Gastroenterology, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China
| | - Hongna Lv
- Department of Gastroenterology and Hepatology, Binzhou People's Hospital, Binzhou, China
| | - Kangkang Wu
- Department of Gastroenterology, Qilu Hospital of Shandong University (Qingdao), Qingdao, China
| | - Ning Shi
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
| | - Xingfang Jia
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
| | - Yonghang Lai
- Qingdao Medicon Digital Engineering Co., Ltd., Qingdao, China
| | - Yiyan Zhang
- Qingdao Medicon Digital Engineering Co., Ltd., Qingdao, China
| | - Zhen Li
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
| | - Ning Zhong
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
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Jain M, Atayan D, Rakhmatullin T, Dakhtler T, Popov P, Kim P, Viborniy M, Gontareva I, Samokhodskaya L, Egorov V. Cell-Free Tumor DNA Detection-Based Liquid Biopsy of Plasma and Bile in Patients with Various Pancreatic Neoplasms. Biomedicines 2024; 12:220. [PMID: 38255325 PMCID: PMC10813046 DOI: 10.3390/biomedicines12010220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
The key challenge of cell-free tumor DNA (cftDNA) analysis in pancreatic ductal adenocarcinoma (PDAC) is overcoming its low detection rate, which is mainly explained by the overall scarcity of this biomarker in plasma. Obstructive jaundice is a frequent event in PDAC, which enables bile collection as a part of routine treatment. The aim of this study was to evaluate the performance of KRAS-mutated cftDNA detection-based liquid biopsy of plasma and bile in patients with pancreatic neoplasms using digital droplet PCR. The study included healthy volunteers (n = 38), patients with PDAC (n = 95, of which 20 had obstructive jaundice) and other pancreatic neoplasms (OPN) (n = 18). The sensitivity and specificity compared to the control group were 61% and 100% (AUC-ROC-0.805), and compared to the OPN group, they were 61% and 94% (AUC-ROC-0.794), respectively. Bile exhibited higher cftDNA levels than plasma (248.6 [6.743; 1068] vs. 3.26 [0; 19.225] copies/mL) and a two-fold higher detection rate (p < 0.01). Plasma cftDNA levels were associated with distant metastases, tumor size, and CA 19-9 (p < 0.05). The probability of survival was worse in patients with higher levels of cftDNA in plasma (hazard ratio-2.4; 95% CI: 1.3-4.6; p = 0.005) but not in bile (p > 0.05). Bile is a promising alternative to plasma in patients with obstructive jaundice, at least for the diagnostic purposes of liquid biopsy.
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Affiliation(s)
- Mark Jain
- Medical Research and Educational Center, Lomonosov Moscow State University, 119992 Moscow, Russia;
| | - David Atayan
- Joint Stock Company “Ilyinsky Hospital”, 143421 Moscow, Russia; (D.A.); (T.D.); (P.P.); (P.K.); (M.V.); (I.G.); (V.E.)
| | - Tagir Rakhmatullin
- Department of Fundamental Medicine, Lomonosov Moscow State University, 119991 Moscow, Russia;
| | - Tatyana Dakhtler
- Joint Stock Company “Ilyinsky Hospital”, 143421 Moscow, Russia; (D.A.); (T.D.); (P.P.); (P.K.); (M.V.); (I.G.); (V.E.)
| | - Pavel Popov
- Joint Stock Company “Ilyinsky Hospital”, 143421 Moscow, Russia; (D.A.); (T.D.); (P.P.); (P.K.); (M.V.); (I.G.); (V.E.)
| | - Pavel Kim
- Joint Stock Company “Ilyinsky Hospital”, 143421 Moscow, Russia; (D.A.); (T.D.); (P.P.); (P.K.); (M.V.); (I.G.); (V.E.)
| | - Mikhail Viborniy
- Joint Stock Company “Ilyinsky Hospital”, 143421 Moscow, Russia; (D.A.); (T.D.); (P.P.); (P.K.); (M.V.); (I.G.); (V.E.)
| | - Iuliia Gontareva
- Joint Stock Company “Ilyinsky Hospital”, 143421 Moscow, Russia; (D.A.); (T.D.); (P.P.); (P.K.); (M.V.); (I.G.); (V.E.)
| | - Larisa Samokhodskaya
- Medical Research and Educational Center, Lomonosov Moscow State University, 119992 Moscow, Russia;
| | - Vyacheslav Egorov
- Joint Stock Company “Ilyinsky Hospital”, 143421 Moscow, Russia; (D.A.); (T.D.); (P.P.); (P.K.); (M.V.); (I.G.); (V.E.)
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Terasawa H, Matsumoto K, Tanaka T, Tomoda T, Ogawa T, Ishihara Y, Kikuchi T, Obata T, Oda T, Matsumi A, Miyamoto K, Morimoto K, Fujii Y, Yamazaki T, Uchida D, Horiguchi S, Tsutsumi K, Kato H, Otsuka M. Cysts or necrotic components in pancreatic ductal adenocarcinoma is associated with the risk of EUS-FNA/B complications including needle tract seeding. Pancreatology 2023; 23:988-995. [PMID: 37951728 DOI: 10.1016/j.pan.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/05/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND EUS-FNA/B for pancreatic ductal adenocarcinoma (PDAC) is generally considered to be safe; however, while the incidence is low, there are occurrences of complications. Among these complications, there are serious ones like needle tract seeding (NTS), and it is not known than which types of tumors have the risks of EUS-FNA/B complications. This study aimed to evaluate the risk of EUS-FNA/B complications in patients with PDAC, focusing on morphological features. METHODS Overall, 442 patients who underwent EUS-FNA/B for solid pancreatic masses between January 2018 and May 2022 in four institutions were retrospectively surveyed. Finally, 361 patients histopathologically diagnosed with PDAC were analyzed. Among these patients, 79 tumors with cysts or necrotic components were compared with 282 tumors without cysts or necrotic components. The incidence and risk of EUS-FNA/B complications including NTS were evaluated. RESULTS There were 9 (2.4 %) of total EUS-FNA/B complications and 3 (0.8 %) of NTS. The incidence of total complication rate and NTS in tumors with cysts or necrotic components were significantly higher than in those without cysts or necrotic components (total complication 6.3 % vs. 1.4 %, p = 0.026, NTS 3.7 % vs. 0 %, p = 0.01). The transgastric route of puncture (OR: 93.3, 95 % CI: 3.81-2284.23) and the existence of cysts or necrotic components (OR: 7.3, 95 % CI: 1.47-36.19) were risk factors for EUS-FNA/B complications identified by the multivariate analysis. CONCLUSIONS We should pay attention to the risks of EUS-FNA/B complications, including NTS, when the tumor has cysts or necrotic components.
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Affiliation(s)
- Hiroyuki Terasawa
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Kazuyuki Matsumoto
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan.
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Takeshi Tomoda
- Department of Gastroenterology, Okayama City Hospital, Okayama, Okayama, Japan
| | - Taiji Ogawa
- Department of Gastroenterology, Tsuyama Chuo Byoin, Tsuyama, Okayama, Japan
| | - Yuki Ishihara
- Department of Gastroenterology, National Hospital Organisation Iwakuni Medical Center, Iwakuni, Yamaguchi, Japan
| | - Tatsuya Kikuchi
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Taisuke Obata
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Takashi Oda
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Akihiro Matsumi
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Kazuya Miyamoto
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Kosaku Morimoto
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Yuki Fujii
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Tatsuhiro Yamazaki
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Daisuke Uchida
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Shigeru Horiguchi
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Koichiro Tsutsumi
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Hironari Kato
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Motoyuki Otsuka
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
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Wiedbrauck D, Flemming P, Hollerbach S. Role of transduodenal endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/FNB) for diagnosis of retroperitoneal fibrosis (Ormond's disease). ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:1623-1627. [PMID: 36972595 DOI: 10.1055/a-2003-9752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Retroperitoneal fibrosis (RPF), often referred to as Ormond's disease when it is of idiopathic origin, is a rare disease characterized by the presence of inflammatory infiltrates and periaortic masses in the retroperitoneum. For a definite diagnosis, a biopsy and subsequent pathological examination is required. Currently accepted methods for retroperitoneal biopsy include open, laparoscopic, or CT-guided approaches. However, transduodenal endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/FNB) for diagnosis of RPF has attracted only little attention in the literature. CASE REPORTS We report two male patient cases who presented with leukocytosis, elevated C-reactive protein, and a suspicious retroperitoneal mass of unknown origin on computed tomography. One patient also reported left lower quadrant pain, whereas the other patient suffered from back pain and weight loss. In both patients, idiopathic RPF was successfully diagnosed by using transduodenal EUS-FNA/FNB with 22- and 20-gauge aspiration needles. Histopathology revealed dense lymphocytic infiltrates and fibrosis. The procedures lasted approximately 25 and 20 minutes, respectively, and in both patients no serious adverse events occurred. Treatment included steroid therapy and administration of Azathioprine. CONCLUSION We demonstrate that using EUS-FNA/FNB to diagnose RPF is a feasible, fast, and safe method, which should always be considered as a first-line diagnostic modality. Hence, this case report emphasizes that gastrointestinal endoscopists are likely to play an important role in the setting of suspected RPF.
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Affiliation(s)
- Damian Wiedbrauck
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
| | | | - Stephan Hollerbach
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
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Lu Q, Du ZQ, Zhou XR, Yang M, Huang R, Liu WH. Aspiration of tissues and ascites: the solution to endoscopic ultrasound-related duodenal perforation during pancreatic cancer sampling. Endoscopy 2023; 55:E1217-E1218. [PMID: 38052422 PMCID: PMC10697788 DOI: 10.1055/a-2208-5363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Affiliation(s)
- Qin Lu
- Department of Gastroenterology and Hepatology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhi-qiang Du
- Department of Gastroenterology, Jianyang People’s Hospital, Jianyang, China
| | - Xiang-rong Zhou
- Department of Gastroenterology, Jianyang People’s Hospital, Jianyang, China
| | - Min Yang
- Department of Gastroenterology and Hepatology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Rui Huang
- Department of Gastroenterology and Hepatology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wei-hui Liu
- Department of Gastroenterology and Hepatology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Qu W, Yang J, Li J, Yuan G, Li S, Chu Q, Xie Q, Zhang Q, Cheng B, Li Z. Avoid non-diagnostic EUS-FNA: a DNN model as a possible gatekeeper to distinguish pancreatic lesions prone to inconclusive biopsy. Br J Radiol 2023; 96:20221112. [PMID: 37195026 PMCID: PMC10607397 DOI: 10.1259/bjr.20221112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/20/2023] [Accepted: 05/11/2023] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVE This work aimed to explore the utility of CT radiomics with machine learning for distinguishing the pancreatic lesions prone to non-diagnostic ultrasound-guided fine-needle aspiration (EUS-FNA). METHODS 498 patients with pancreatic EUS-FNA were retrospectively reviewed [Development cohort: 147 pancreatic ductal adenocarcinoma (PDAC); Validation cohort: 37 PDAC]. Pancreatic lesions not PDAC were also tested exploratively. Radiomics extracted from contrast-enhanced CT was integrated with deep neural networks (DNN) after dimension reduction. The receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) were performed for model evaluation. And, the explainability of the DNN model was analyzed by integrated gradients. RESULTS The DNN model was effective in distinguishing PDAC lesions prone to non-diagnostic EUS-FNA (Development cohort: AUC = 0.821, 95% CI: 0.742-0.900; Validation cohort: AUC = 0.745, 95% CI: 0.534-0.956). In all cohorts, the DNN model showed better utility than the logistic model based on traditional lesion characteristics with NRI >0 (p < 0.05). And, the DNN model had net benefits of 21.6% at the risk threshold of 0.60 in the validation cohort. As for the model explainability, gray-level co-occurrence matrix (GLCM) features contributed the most averagely and the first-order features were the most important in the sum attribution. CONCLUSION The CT radiomics-based DNN model can be a useful auxiliary tool for distinguishing the pancreatic lesions prone to nondiagnostic EUS-FNA and provide alerts for endoscopists preoperatively to reduce unnecessary EUS-FNA. ADVANCES IN KNOWLEDGE This is the first investigation into the utility of CT radiomics-based machine learning in avoiding non-diagnostic EUS-FNA for patients with pancreatic masses and providing potential pre-operative assistance for endoscopists.
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Affiliation(s)
- Weinuo Qu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiannan Yang
- School of Data Science, City University of Hong Kong, Kowloon, Hong Kong, China
| | - Jiali Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guanjie Yuan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shichao Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qian Chu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qingguo Xie
- Biomedical Engineering Department, College of Life Sciences and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | - Bin Cheng
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Levink IJM, Jaarsma SC, Koopmann BDM, van Riet PA, Overbeek KA, Meziani J, Sprij MLJA, Casadei R, Ingaldi C, Polkowski M, Engels MML, van der Waaij LA, Carrara S, Pando E, Vornhülz M, Honkoop P, Schoon EJ, Laukkarinen J, Bergmann JF, Rossi G, van Vilsteren FGI, van Berkel A, Tabone T, Schwartz MP, Tan ACITL, van Hooft JE, Quispel R, van Soest E, Czacko L, Bruno MJ, Cahen DL, the PACYFIC‐registry work group. The additive value of CA19.9 monitoring in a pancreatic cyst surveillance program. United European Gastroenterol J 2023; 11:601-611. [PMID: 37435855 PMCID: PMC10493362 DOI: 10.1002/ueg2.12422] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/05/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Surveillance of pancreatic cysts focuses on the detection of (mostly morphologic) features warranting surgery. European guidelines consider elevated CA19.9 as a relative indication for surgery. We aimed to evaluate the role of CA19.9 monitoring for early detection and management in a cyst surveillance population. METHODS The PACYFIC-registry is a prospective collaboration that investigates the yield of pancreatic cyst surveillance performed at the discretion of the treating physician. We included participants for whom at least one serum CA19.9 value was determined by a minimum follow-up of 12 months. RESULTS Of 1865 PACYFIC participants, 685 met the inclusion criteria for this study (mean age 67 years, SD 10; 61% female). During a median follow-up of 25 months (IQR 24, 1966 visits), 29 participants developed high-grade dysplasia (HGD) or pancreatic cancer. At baseline, CA19.9 ranged from 1 to 591 kU/L (median 10 kU/L [IQR 14]), and was elevated (≥37 kU/L) in 64 participants (9%). During 191 of 1966 visits (10%), an elevated CA19.9 was detected, and these visits more often led to an intensified follow-up (42%) than those without an elevated CA19.9 (27%; p < 0.001). An elevated CA19.9 was the sole reason for surgery in five participants with benign disease (10%). The baseline CA19.9 value was (as continuous or dichotomous variable at the 37 kU/L threshold) not independently associated with HGD or pancreatic cancer development, whilst a CA19.9 of ≥ 133 kU/L was (HR 3.8, 95% CI 1.1-13, p = 0.03). CONCLUSIONS In this pancreatic cyst surveillance cohort, CA19.9 monitoring caused substantial harm by shortening surveillance intervals (and performance of unnecessary surgery). The current CA19.9 cutoff was not predictive of HGD and pancreatic cancer, whereas a higher cutoff may decrease false-positive values. The role of CA19.9 monitoring should be critically appraised prior to implementation in surveillance programs and guidelines.
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Affiliation(s)
- Iris J. M. Levink
- Department of Gastroenterology & HepatologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Sanne C. Jaarsma
- Department of Gastroenterology & HepatologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Brechtje D. M. Koopmann
- Department of Gastroenterology & HepatologyErasmus University Medical CenterRotterdamThe Netherlands
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | - Priscilla A. van Riet
- Department of Gastroenterology & HepatologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Kasper A. Overbeek
- Department of Gastroenterology & HepatologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Jihane Meziani
- Department of Gastroenterology & HepatologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Marloes L. J. A. Sprij
- Department of Gastroenterology & HepatologyErasmus University Medical CenterRotterdamThe Netherlands
| | | | | | - Marcin Polkowski
- Department of Gastroenterology, Hepatology, and Clinical OncologyCenter of Postgraduate Medical EducationWarsawPoland
- Department of Oncological GastroenterologyThe Maria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Megan M. L. Engels
- Department of Gastroenterology & HepatologyMayo ClinicJacksonvilleFloridaUSA
- Department of Gastroenterology & HepatologyLeiden University Medical CenterLeidenThe Netherlands
| | | | - Silvia Carrara
- Department of GastroenterologyIRCCS Humanitas Research HospitalMilanItaly
| | - Elizabeth Pando
- Department of SurgeryVall d’Hebron Institute of ResearchBarcelonaSpain
| | - Marlies Vornhülz
- Department of Gastroenterology & HepatologyLudwig‐Maximilians‐University of MunichMunichGermany
| | - Pieter Honkoop
- Department of Gastroenterology & HepatologyAlbert Schweitzer HospitalDordrechtThe Netherlands
| | - Erik J. Schoon
- Department of Gastroenterology & HepatologyCatharina HospitalEindhovenThe Netherlands
| | | | - Jilling F. Bergmann
- Department of Gastroenterology & HepatologyHaga ZiekenhuisThe HagueThe Netherlands
| | - Gemma Rossi
- Pancreato‐Biliary Endoscopy and Endosonography DivisionPancreas Translational and Clinical Research CenterSan Raffaele Scientific Institute IRCCSVita Salute San Raffaele UniversityMilanItaly
| | | | | | - Trevor Tabone
- Department of Gastroenterology & HepatologyMater dei HospitalMsidaMalta
| | - Matthijs P. Schwartz
- Department of Gastroenterology & HepatologyMeander Medical CenterAmersfoortThe Netherlands
| | - Adriaan C. I. T. L. Tan
- Department of Gastroenterology & HepatologyCanisius Wilhelmina HospitalNijmegenThe Netherlands
| | - Jeanin E. van Hooft
- Department of Gastroenterology & HepatologyLeiden University Medical CenterLeidenThe Netherlands
- Department of Gastroenterology & HepatologyAmsterdam UMCAmsterdamThe Netherlands
| | - Rutger Quispel
- Department of Gastroenterology & HepatologyReinier de GraafDelftThe Netherlands
| | - Ellert van Soest
- Department of Gastroenterology & HepatologySpaarne GasthuisHaarlemThe Netherlands
| | - Laszlo Czacko
- Department of Gastroenterology & HepatologyUniversity of SzegedSzegedHungary
| | - Marco J. Bruno
- Department of Gastroenterology & HepatologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Djuna L. Cahen
- Department of Gastroenterology & HepatologyErasmus University Medical CenterRotterdamThe Netherlands
- Department of Gastroenterology & HepatologyAmstellandAmstelveenThe Netherlands
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Qin X, Zhang M, Zhou C, Ran T, Pan Y, Deng Y, Xie X, Zhang Y, Gong T, Zhang B, Zhang L, Wang Y, Li Q, Wang D, Gao L, Zou D. A deep learning model using hyperspectral image for EUS-FNA cytology diagnosis in pancreatic ductal adenocarcinoma. Cancer Med 2023; 12:17005-17017. [PMID: 37455599 PMCID: PMC10501295 DOI: 10.1002/cam4.6335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 06/12/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND AND AIMS Endoscopic ultrasonography-guided fine-needle aspiration/biopsy (EUS-FNA/B) is considered to be a first-line procedure for the pathological diagnosis of pancreatic cancer owing to its high accuracy and low complication rate. The number of new cases of pancreatic ductal adenocarcinoma (PDAC) is increasing, and its accurate pathological diagnosis poses a challenge for cytopathologists. Our aim was to develop a hyperspectral imaging (HSI)-based convolution neural network (CNN) algorithm to aid in the diagnosis of pancreatic EUS-FNA cytology specimens. METHODS HSI images were captured of pancreatic EUS-FNA cytological specimens from benign pancreatic tissues (n = 33) and PDAC (n = 39) prepared using a liquid-based cytology method. A CNN was established to test the diagnostic performance, and Attribution Guided Factorization Visualization (AGF-Visualization) was used to visualize the regions of important classification features identified by the model. RESULTS A total of 1913 HSI images were obtained. Our ResNet18-SimSiam model achieved an accuracy of 0.9204, sensitivity of 0.9310 and specificity of 0.9123 (area under the curve of 0.9625) when trained on HSI images for the differentiation of PDAC cytological specimens from benign pancreatic cells. AGF-Visualization confirmed that the diagnoses were based on the features of tumor cell nuclei. CONCLUSIONS An HSI-based model was developed to diagnose cytological PDAC specimens obtained using EUS-guided sampling. Under the supervision of experienced cytopathologists, we performed multi-staged consecutive in-depth learning of the model. Its superior diagnostic performance could be of value for cytologists when diagnosing PDAC.
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Affiliation(s)
- Xianzheng Qin
- Department of GastroenterologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Minmin Zhang
- Department of GastroenterologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Chunhua Zhou
- Department of GastroenterologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Taojing Ran
- Department of GastroenterologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Yundi Pan
- Department of GastroenterologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Yingjiao Deng
- Shanghai Key Laboratory of Multidimensional Information ProcessingEast China Normal UniversityShanghaiChina
| | - Xingran Xie
- Shanghai Key Laboratory of Multidimensional Information ProcessingEast China Normal UniversityShanghaiChina
| | - Yao Zhang
- Department of GastroenterologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Tingting Gong
- Department of GastroenterologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Benyan Zhang
- Department of PathologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Ling Zhang
- Department of GastroenterologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Yan Wang
- Shanghai Key Laboratory of Multidimensional Information ProcessingEast China Normal UniversityShanghaiChina
| | - Qingli Li
- Shanghai Key Laboratory of Multidimensional Information ProcessingEast China Normal UniversityShanghaiChina
| | - Dong Wang
- Department of GastroenterologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Lili Gao
- Department of PathologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
| | - Duowu Zou
- Department of GastroenterologyRuijin Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghaiChina
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Qu W, Zhou Z, Yuan G, Li S, Li J, Chu Q, Zhang Q, Xie Q, Li Z, Kamel IR. Is the radiomics-clinical combined model helpful in distinguishing between pancreatic cancer and mass-forming pancreatitis? Eur J Radiol 2023; 164:110857. [PMID: 37172441 DOI: 10.1016/j.ejrad.2023.110857] [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: 11/02/2022] [Revised: 03/22/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE To develop CT-based radiomics models for distinguishing between resectable PDAC and mass-forming pancreatitis (MFP) and to provide a non-invasive tool for cases of equivocal imaging findings with EUS-FNA needed. METHODS A total of 201 patients with resectable PDAC and 54 patients with MFP were included. Development cohort: patients without preoperative EUS-FNA (175 PDAC cases, 38 MFP cases); validation cohort: patients with EUS-FNA (26 PDAC cases, 16 MFP cases). Two radiomic signatures (LASSOscore, PCAscore) were developed based on the LASSO model and principal component analysis. LASSOCli and PCACli prediction models were established by combining clinical features with CT radiomic features. ROC analysis and decision curve analysis (DCA) were performed to evaluate the utility of the model versus EUS-FNA in the validation cohort. RESULTS In the validation cohort, the radiomic signatures (LASSOscore, PCAscore) were both effective in distinguishing between resectable PDAC and MFP (AUCLASSO = 0.743, 95% CI: 0.590-0.896; AUCPCA = 0.788, 95% CI: 0.639-0.938) and improved the diagnostic accuracy of the baseline onlyCli model (AUConlyCli = 0.760, 95% CI: 0.614-0.960) after combination with variables including age, CA19-9, and the double-duct sign (AUCPCACli = 0.880, 95% CI: 0.776-0.983; AUCLASSOCli = 0.825, 95% CI: 0.694-0.955). The PCACli model showed comparable performance to FNA (AUCFNA = 0.810, 95% CI: 0.685-0.935). In DCA, the net benefit of the PCACli model was superior to that of EUS-FNA, avoiding biopsies in 70 per 1000 patients at a risk threshold of 35%. CONCLUSIONS The PCACli model showed comparable performance with EUS-FNA in discriminating resectable PDAC from MFP.
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Affiliation(s)
- Weinuo Qu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Ziling Zhou
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Biomedical Engineering Department, College of Life Sciences and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Guanjie Yuan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Shichao Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Jiali Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Qian Chu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Qingpeng Zhang
- Musketeers Foundation Institute of Data Science, The University of Hong Kong, Hong Kong Special Administrative Region; The Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region.
| | - Qingguo Xie
- Biomedical Engineering Department, College of Life Sciences and Technology, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Ihab R Kamel
- Johns Hopkins Hospital, Russell H Morgan Department of Radiology & Radiological Science, 600 N Wolfe St, Baltimore, MD 21205, USA.
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Giri S, Afzalpurkar S, Anirvan P, Angadi S, Kasturi S, Varghese J, Sundaram S. Risk of Bleeding with Endoscopic Ultrasound-Guided Tissue Acquisition in Patients on Antithrombotic Therapy: A Systematic Review and Meta-Analysis. Dig Dis Sci 2023; 68:1950-1958. [PMID: 36609733 DOI: 10.1007/s10620-022-07808-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/17/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND The present guidelines stratify endoscopic ultrasound-guided tissue acquisition (EUS-TA) as a high-bleeding risk procedure in patients on antithrombotics. However, the data regarding the same are conflicting. Therefore, this meta-analysis aimed to analyze the bleeding event rates associated with EUS-TA in patients receiving antithrombotic therapy. METHODS A literature search from January 2000 to August 2022 was done for studies on EUS-guided TA in patients receiving antithrombotics. The primary outcome was incidence of overall and major bleeding. Pooled event rates across studies were expressed with summative statistics. RESULTS A total of 12 studies were included in the meta-analysis. The pooled risk of overall bleeding and major bleeding in patients on antithrombotics was 2.0% (0.6-3.4) and 0.8% (0.0-1.6), respectively. In patients taking thienopyridine or anticoagulants, the pooled risk of overall bleeding and major bleeding was 2.4% (0.9-3.9) and 1.7% (0.4-3.1), respectively. Patients on antithrombotics had a higher odd of overall bleeding (OR 2.12, 1.20-3.83) and major bleeding (OR 3.58, 1.11-11.52) compared to controls. The odds of overall bleeding (OR 0.95, 95%CI 0.38-2.42) and major bleeding (OR 1.57, 95%CI 0.45-5.54) were comparable between patients on antithrombotics who continued and those who discontinued it preprocedural. CONCLUSION Despite an increase risk of bleeding with EUS-TA in patients on antithrombotics, the pooled incidence remains low. Compared to the previous guidelines stating thienopyridine use as high risk for bleeding, the present analysis showed a bleeding rate of less than 1%. Discontinuing antithrombotics prior to EUS-TA does not reduce the bleeding risk significantly, requiring strict monitoring.
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Affiliation(s)
- Suprabhat Giri
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Shivaraj Afzalpurkar
- Institute of Gastrosciences and Liver, Apollo Multispecialty Hospital, Kolkata, India
| | - Prajna Anirvan
- Department of Gastroenterology, SCB Medical College & Hospital, Cuttack, India
| | - Sumaswi Angadi
- Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Sunil Kasturi
- Department of Gastroenterology, Fortis Hospital, Bengaluru, India
| | - Jijo Varghese
- Department of Gastroenterology, KM Cherian Institute of Medical Sciences, Kallissery, India
| | - Sridhar Sundaram
- Department of Digestive Disease and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, 400012, India.
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Möller K, Jenssen C, Braden B, Hocke M, Yamashita Y, Arcidiacono PG, Ignee A, D’Onofrio M, Fusaroli P, Bhutani MS, Dong Y, Sun S, Faiss S, Dietrich CF. Comments on and Illustrations of the EFSUMB CEUS Guidelines: Transabdominal and Endoscopic Ultrasound Features of Intrapancreatic Metastases and the Role of Multiparametric Imaging and EUS-Guided Sampling in Rare Pancreatic Tumors. Cancers (Basel) 2023; 15:2546. [PMID: 37174015 PMCID: PMC10177255 DOI: 10.3390/cancers15092546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
A definite pathologic diagnosis of intrapancreatic metastasis is crucial for the management decision, i.e., curative or palliative surgery versus chemotherapy or conservative/palliative therapy. This review focuses on the appearance of intrapancreatic metastases on native and contrast-enhanced transabdominal ultrasound and endoscopic ultrasound. Differences and similarities in relation to the primary tumor, and the differential diagnosis from pancreatic carcinoma and neuroendocrine neoplasms are described. The frequency of intrapancreatic metastases in autopsy studies and surgical resection studies will be discussed. Further emphasis is placed on endoscopic ultrasound-guided sampling to confirm the diagnosis.
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Affiliation(s)
- Kathleen Möller
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, 10365 Berlin, Germany
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch-Oderland, 15344 Strausberg, Germany
- Brandenburg Institute for Clinical Ultrasound (BICUS), Medical University Brandenburg, 16816 Neuruppin, Germany
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, OX3 9DU Oxford, UK
| | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, 98617 Meiningen, Germany
| | - Yasunobu Yamashita
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama City 641-8509, Japan
| | - Paolo Giorgio Arcidiacono
- Division of Pancreatobiliary Endoscopy and Endosonography, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - André Ignee
- Medical Clinic—Department for Gastroenterology and Rheumatology, Klinikum Wuerzburg Mitte, 97070 Wuerzburg, Germany
| | - Mirko D’Onofrio
- Department of Radiology, GB Rossi University Hospital, University of Verona, 37129 Verona, Italy
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastrointestinal Unit, University of Bologna/Hospital of Imola, 40126 Bologna, Italy
| | - Manoop S. Bhutani
- Department of Gastroenterology Hepatology and Nutrition, UTMD Anderson Cancer Center, Houston, TX 77030-4009, USA
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Siyu Sun
- Department of Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110022, China
| | - Siegbert Faiss
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, 10365 Berlin, Germany
| | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin der Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, 3013 Bern, Switzerland
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Serra Mitjà P, Gonçalves Dos Santos Carvalho F, Garcia Olivé I, Sanz Santos J, Jiménez López J, Núñez Ares A, Tomás López L, Centeno Clemente C, Tazi R, Castellà E, Abad Capa J, Rosell Gratacós A, Andreo Garcia F. Incidence and Risk Factors for Infectious Complications of EBUS-TBNA: Prospective Multicenter Study. Arch Bronconeumol 2023; 59:84-89. [PMID: 36446657 DOI: 10.1016/j.arbres.2022.10.007] [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: 08/18/2022] [Revised: 09/29/2022] [Accepted: 10/21/2022] [Indexed: 11/17/2022]
Abstract
The aim of our study was to describe the incidence of infectious complications of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) and to analyze the potential risk factors in a prospective cohort of patients. METHODS We conducted a prospective multicenter study, with all consecutive patients referred for an EBUS-TBNA with patients at risk of developing an infectious complication (considering>10 nodal samplings, known immunosuppression, bronchial colonization and cavitated or necrotic lesions) and a second group without any risk factor. RESULTS Three hundred seventy patients were included: 245 with risk factors and 125 without risk factors (as the control group). Overall, 15 patients (4.05%) presented an acute infectious complication: fourteen in cases (5.7%) and 1 in controls (0.8%). Of these, 4 patients presented pneumonia, 1 mediastinitis, 4 obstructive pneumonitis and 6 mild complications (respiratory tract infection that resolved with antibiotic). Also 7 (1.9%) patients had self-limited fever. One-month follow-up showed 1 mediastinitis at sixteenth day post-EBUS, which required surgical treatment, and 3 pneumonias and 3 respiratory tract infections at nineteenth day (1.9%). All patients had a good evolution and there were no deaths related with infectious complication. We observed an increased risk of complication in patients with risk factors and in patients with necrosis (p=0.018). CONCLUSIONS The incidence of infectious complications in a subgroup of patients with risk factors was higher than in patients without risk factors. Nevertheless, it remains low, and no fatal complication occurred, which reinforces the idea that EBUS-TBNA is a safe technique for the assessment of the mediastinum. Necrotic lesions are a risk factor of post-EBUS infection, and their puncture should be avoided.
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Affiliation(s)
- Pere Serra Mitjà
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, IGTP, Spain.
| | | | - Ignasi Garcia Olivé
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, IGTP, Spain
| | | | | | | | | | - Carmen Centeno Clemente
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, IGTP, Spain
| | - Rachid Tazi
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, IGTP, Spain
| | - Eva Castellà
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jorge Abad Capa
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, IGTP, Spain; Universitat Autònoma de Barcelona, UAB, Spain
| | - Antoni Rosell Gratacós
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, IGTP, Spain; Universitat Autònoma de Barcelona, UAB, Spain
| | - Felipe Andreo Garcia
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, IGTP, Spain; Universitat Autònoma de Barcelona, UAB, Spain
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Li Z, Liu W, Xu X, Li P. A Meta-Analysis Comparing Endoscopic Ultrasound-guided Fine-needle Aspiration With Endoscopic Ultrasound-guided Fine-needle Biopsy. J Clin Gastroenterol 2022; 56:668-678. [PMID: 35470294 DOI: 10.1097/mcg.0000000000001702] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The superiority between endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is still a debate. The purpose of this meta-analysis was to compare the diagnostic value and safety of these 2 needles in sampling of all solid lesions and separately pancreatic lesions. MATERIALS AND METHODS PubMed, EMBASE, and the Cochrane library were searched for randomized controlled studies that reported the comparison of FNA and FNB in solid mass. Outcome measures included diagnostic accuracy, number of needle passes, diagnostic adequacy, presence of tissue cores, and adverse events. Standard error, upper and lower confidence intervals at 95% confidence interval for the risk were obtained using Review Manager Version 5.3 which was also used to generate forest plots for pooled analysis. The random or fixed effect model was applied depending on the heterogeneity ( I2 ). RESULTS Eighteen randomized control trial studies with a total of 2718 patients (1141 patients with EUS-FNA, 1108 with EUS-FNB, and remaining 469 patients were sampled with both needles alternatively) were included in the meta-analysis.FNB group has relatively good diagnostic accuracy relative risk (RR): 0.94, 0.92-0.97; P =0.0002), diagnostic adequacy (RR: 0.95, 0.9-1.0; P =0.04) and high quality histologic yield compared (RR: 0.77, 0.64-0.93; P =0.007) with the FNA group in solid gastrointestinal lesions, and the number of needle passes to obtain sufficient tissue (mean difference: 0.54, 0.45-0.64; P <0.00001) was lower in the FNB group. For solid pancreatic disease only, there was no difference in diagnostic accuracy (RR: 0.97, 0.93-1.01, P =0.13) or quality histologic yield (RR: 0.60, 0.29-1.23; P =0.16). The rate of adverse events (RR: 1.04, 0.48-2.29; P =0.92) did not significantly differ between FNA and FNB groups. CONCLUSIONS In solid gastrointestinal lesions, FNB is associated with a relatively better diagnostic adequacy, diagnostic adequacy and tissue cores rates, and less number of needle passes. For solid pancreatic disease only, there is no difference in diagnostic accuracy or tissue cores rates.
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Affiliation(s)
| | - Wei Liu
- Gastroenterology, The First People's Hospital of Chenzhou, Chenzhou, Hunan, China
| | - Xiaoda Xu
- Gastroenterology, The First People's Hospital of Chenzhou, Chenzhou, Hunan, China
| | - Peiyu Li
- Gastroenterology, The First People's Hospital of Chenzhou, Chenzhou, Hunan, China
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Chen X, Chen X, Yu X, He X. EUS-guided fine needle aspiration provides an open view for duodenal obstruction caused by urothelial carcinoma: a case report. BMC Gastroenterol 2022; 22:376. [PMID: 35941530 PMCID: PMC9358900 DOI: 10.1186/s12876-022-02452-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/27/2022] [Indexed: 12/02/2022] Open
Abstract
Background Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a good alternative and diagnostic tool for gastrointestinal wall thickening with prior negative endoscopic biopsies. Case presentation Here we reported a case of a 60-years-old woman admitted with atrophic right kidney and hydronephrosis and intermittent postprandial bloating. Esophagogastroduodenoscopy and small bowel endoscopy revealed wall thickening and stenosis at the junction of the descending and inferior duodenum. Biopsies from endoscopy showed no specific findings. EUS-FNA of the thickened duodenal wall was performed and histopathological examinations revealed poorly differentiated carcinoma. Immunohistochemically staining was positive for pan-cytokeratin, CK7, CK20, and weakly positive for GATA-3 and P63. These results were highly suggestive of metastatic urothelial cancer. Conclusions EUS-FNA played an important role in the diagnosis of unexplained gastrointestinal wall thickening and rare metastases to the gastrointestinal wall.
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Affiliation(s)
- Xiaoli Chen
- Division of Gastroenterology, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China.
| | - Xin Chen
- Division of Gastroenterology, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Xiaoli Yu
- Division of Pathology, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Xingkang He
- Division of Gastroenterology, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China.
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Möller K, Dietrich CF, Faiss S, Mutze S, Goelz L. [Alternatives of histological material collection - When and how is histological confirmation by ultrasound (US), computer tomography (CT) or endosonography (EUS) useful?]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:937-958. [PMID: 34781389 DOI: 10.1055/a-1482-9448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Histological classifications of tumorous lesions together with adequate staging are necessary for stage-appropriate and personalized therapies. The indications, technical possibilities, and limitations as well as potential complications of image-guided needle biopsy by ultrasound, computed tomography, and endosonography are described. Which procedure for which organ and which lesion?
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Affiliation(s)
- Kathleen Möller
- Klinik für Innere Medizin/Gastroenterologie, Berlin, Germany, SANA-Klinikum, Berlin, Germany
| | | | - Siegbert Faiss
- Klinik für Innere Medizin/Gastroenterologie, Berlin, Germany, SANA-Klinikum, Berlin, Germany
| | - Sven Mutze
- Institut für Radiologie und Neuroradiologie, BG Unfallkrankenhaus Berlin, Berlin, Germany
- Institut für Radiologie, SANA-Klinikum, Berlin, Germany
- Institut für Diagnostische Radiologie, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Leonie Goelz
- Institut für Radiologie und Neuroradiologie, BG Unfallkrankenhaus Berlin, Berlin, Germany
- Institut für Diagnostische Radiologie, Universitätsmedizin Greifswald, Greifswald, Germany
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Lai JH, Lee KH, Chang CW, Chen MJ, Lin CC. Predicting Factors for Pancreatic Malignancy with Computed Tomography and Endoscopic Ultrasonography in Chronic Pancreatitis. Diagnostics (Basel) 2022; 12:1004. [PMID: 35454052 PMCID: PMC9030339 DOI: 10.3390/diagnostics12041004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 02/01/2023] Open
Abstract
Diagnosing pancreatic malignancy is challenging, especially in patients with chronic pancreatitis (CP). Endoscopic ultrasonography (EUS) is a promising diagnostic procedure for discriminating between malignancy and CP. We aimed to investigate the predictive factors and reliability of computed tomography (CT) and EUS for differentiating pancreatic mass lesions and the diagnostic accuracy of EUS-FNA or FNB in patients with CP. Forty patients with CP, receiving CT and EUS-FNA or FNB for pancreatic mass lesion evaluation, were enrolled in the study. Patients’ data, CT and EUS characteristics, image-based diagnosis, cytopathology, and final diagnosis were recorded. EUS was superior to CT in terms of diagnostic accuracy (92.5% vs. 82.5%, p = 0.02). Both CT and EUS showed significant predictive factors (all p < 0.05) with the tumor image hypoattenuation pattern or vessel invasion on CT and pancreatic duct dilatation, or distal pancreatic atrophy on EUS. EUS imaging is a reliable modality for evaluating pancreatic lesions, even with a CP background. The EUS image has a higher diagnostic accuracy than CT. Predicting factors, including hypoechoic pattern, pancreatic duct dilatation, and distal pancreas atrophy, may help to differentiate benign or malignant in patients with CP.
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Affiliation(s)
- Jian-Han Lai
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan; (J.-H.L.); (K.-H.L.); (C.-W.C.); (M.-J.C.)
- Department of Nursing, MacKay Medicine, Nursing and Management College, Taipei 11260, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei 25245, Taiwan
| | - Keng-Han Lee
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan; (J.-H.L.); (K.-H.L.); (C.-W.C.); (M.-J.C.)
| | - Chen-Wang Chang
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan; (J.-H.L.); (K.-H.L.); (C.-W.C.); (M.-J.C.)
- Department of Nursing, MacKay Medicine, Nursing and Management College, Taipei 11260, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei 25245, Taiwan
| | - Ming-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan; (J.-H.L.); (K.-H.L.); (C.-W.C.); (M.-J.C.)
- Department of Nursing, MacKay Medicine, Nursing and Management College, Taipei 11260, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei 25245, Taiwan
| | - Ching-Chung Lin
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan; (J.-H.L.); (K.-H.L.); (C.-W.C.); (M.-J.C.)
- Department of Medicine, MacKay Medical College, New Taipei 25245, Taiwan
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Fujita A, Tashima T, Tanisaka Y, Mizuide M, Ogawa T, Saito Y, Katsuda H, Miyaguchi K, Mashimo Y, Nakano Y, Terada R, Jinushi R, Ryozawa S. Endoscopic closure using an over‐the‐scope clip for pancreatobiliary endoscopy‐related large gastrointestinal perforation (with video). DEN OPEN 2022; 2:e48. [PMID: 35310693 PMCID: PMC8828168 DOI: 10.1002/deo2.48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 11/06/2022]
Abstract
Endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) for pancreatobiliary diseases require advanced techniques. We usually use an oblique‐viewing endoscope in such procedures. Sometimes, tumor invasion causes gastrointestinal strictures. Crossing a stricture using an oblique‐viewing endoscope is more difficult than using a forward‐viewing scope. Therefore, the frequency of scope perforation is higher than other endoscopic procedures. Although surgical repair for gastrointestinal perforations caused by endoscopes has been performed, patients with pancreatobiliary diseases are often elderly and in poor general condition; therefore, patients are hesitant to undergo surgical treatments. Recently, the usefulness of over‐the‐scope clipping (OTSC) as a minimally invasive rescue method has also been reported. In this study, we report cases of successful endoscopic closure using OTSC for gastrointestinal perforations caused by endoscopes in ERCP and EUS‐related procedures. After those procedures, all cases showed no abnormalities in blood tests or symptoms, and emergency surgery was successfully avoided. Thus, endoscopic closure using OTSC for pancreatobiliary endoscopy‐related gastrointestinal perforations is safe and effective. However, OTSC requires some expertise. A good assessment of defect size and careful insertion of the scope using OTSC attached to the upper esophagus are needed to avoid clip migration or disinsertion and esophageal tears. Therefore, endoscopic closure using OTSC could be the first choice of treatment for pancreatobiliary endoscopy‐related gastrointestinal perforations. We should be familiar with its indication and perform it carefully and rapidly.
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Affiliation(s)
- Akashi Fujita
- Department of Gastroenterology Saitama Medical University International Medical Center Hidaka Saitama Japan
| | - Tomoaki Tashima
- Department of Gastroenterology Saitama Medical University International Medical Center Hidaka Saitama Japan
| | - Yuki Tanisaka
- Department of Gastroenterology Saitama Medical University International Medical Center Hidaka Saitama Japan
| | - Masafumi Mizuide
- Department of Gastroenterology Saitama Medical University International Medical Center Hidaka Saitama Japan
| | - Tomoya Ogawa
- Department of Gastroenterology Saitama Medical University International Medical Center Hidaka Saitama Japan
| | - Yoichi Saito
- Department of Gastroenterology Saitama Medical University International Medical Center Hidaka Saitama Japan
| | - Hiromune Katsuda
- Department of Gastroenterology Saitama Medical University International Medical Center Hidaka Saitama Japan
| | - Kazuya Miyaguchi
- Department of Gastroenterology Saitama Medical University International Medical Center Hidaka Saitama Japan
| | - Yumi Mashimo
- Department of Gastroenterology Saitama Medical University International Medical Center Hidaka Saitama Japan
| | - Yuya Nakano
- Department of Gastroenterology Saitama Medical University International Medical Center Hidaka Saitama Japan
| | - Rie Terada
- Department of Gastroenterology Saitama Medical University International Medical Center Hidaka Saitama Japan
| | - Ryuhei Jinushi
- Department of Gastroenterology Saitama Medical University International Medical Center Hidaka Saitama Japan
| | - Shomei Ryozawa
- Department of Gastroenterology Saitama Medical University International Medical Center Hidaka Saitama Japan
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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: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [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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Diagnosis of Pancreatic Solid Lesions, Subepithelial Lesions, and Lymph Nodes Using Endoscopic Ultrasound. J Clin Med 2021; 10:jcm10051076. [PMID: 33807558 PMCID: PMC7961381 DOI: 10.3390/jcm10051076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022] Open
Abstract
Currently, endoscopic ultrasound (EUS) has become widely accepted and has considerable advantages over computed tomography (CT) and other imaging modalities, given that it enables echostructure assessment in lesions with <1 cm diameter and permits high resolution imaging. EUS-guided tissue acquisition (EUS-TA) provides consistent results under ultrasound guidance and has been considered more effective compared to CT- or ultrasound-guided lesion biopsy. Moreover, complication rates, including pancreatitis and bleeding, have been extremely low, with <1% morbidity and mortality rates, thereby suggesting the exceptional overall safety of EUS-TA. The aggressive use of EUS for various lesions has been key in facilitating early diagnosis and therapy. This review summarizes the diagnostic ability of EUS for pancreatic solid lesions, subepithelial lesions, and lymph nodes where it is mainly used. EUS has played an important role in diagnosing these lesions and planning treatment strategies. Future developments in EUS imaging technology, such as producing images close to histopathological findings, are expected to further improve its diagnostic ability. Moreover, tissue acquisition via EUS is expected to be used for precision medicine, which facilitates the selection of an appropriate therapeutic agent by increasing the amount of tissue collected and improving genetic analysis.
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Tanisaka Y, Mizuide M, Fujita A, Ogawa T, Suzuki M, Katsuda H, Saito Y, Miyaguchi K, Tashima T, Mashimo Y, Ryozawa S. Diagnostic Process Using Endoscopy for Biliary Strictures: A Narrative Review. J Clin Med 2021; 10:jcm10051048. [PMID: 33802525 PMCID: PMC7961606 DOI: 10.3390/jcm10051048] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/17/2021] [Accepted: 02/27/2021] [Indexed: 12/13/2022] Open
Abstract
The diagnostic process for biliary strictures remains challenging in some cases. A broad differential diagnosis exists for indeterminate biliary strictures, including benign or malignant lesions. The diagnosis of indeterminate biliary strictures requires a combination of physical examination, laboratory testing, imaging modalities, and endoscopic procedures. Despite the progress of less invasive imaging modalities such as transabdominal ultrasonography, computed tomography, and magnetic resonance imaging, endoscopy plays an essential role in the accurate diagnosis, including the histological diagnosis. Imaging findings and brush cytology and/or forceps biopsy under fluoroscopic guidance with endoscopic retrograde cholangiopancreatography (ERCP) are widely used as the gold standard for the diagnosis of biliary strictures. However, ERCP cannot provide an intraluminal view of the biliary lesion, and its outcomes are not satisfactory. Recently, peroral cholangioscopy, confocal laser endomicroscopy, endoscopic ultrasound (EUS), and EUS-guided fine-needle aspiration have been reported as useful for indeterminate biliary strictures. Appropriate endoscopic modalities need to be selected according to the patient's condition, the lesion, and the expertise of the endoscopist. The aim of this review article is to discuss the diagnostic process for indeterminate biliary strictures using endoscopy.
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