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2013| April-June | Volume 2 | Issue 2
Online since
September 6, 2013
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REVIEWS
Forward-view endoscopic ultrasound: A systematic review of diagnostic and therapeutic applications
Pietro Fusaroli, Liza Ceroni, Giancarlo Caletti
April-June 2013, 2(2):64-70
DOI
:10.4103/2303-9027.117689
PMID
:24949367
Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) and therapeutic procedures have been performed by a curved linear array (CLA) echoendoscope since the early 1990's. This particular echoendoscope, allowing real time visualization of aspiration needles and of other devices, has substantially remained unchanged since its introduction to the market. In a context of rapidly expanding indications for EUS-guided procedures, a dedicated forward view (FV) echoendoscope has been developed and tested under different clinical conditions. The FV echoendoscope is equipped with front endoscopic and EUS view, allowing deployment of needles and other devices through the working channel in straight direction. Several new diagnostic and therapeutic applications may thereby potentially be feasible with the FV echoendoscope and the established ones may prove easier to accomplish. The published literature with the FV echoendoscope has been systematically reviewed and the results are presented analytically and discussed in detail. EUS-FNA and therapeutic procedures, including pancreatic pseudocyst drainage, treatment of gastric fundal varices, celiac plexus neurolysis, and duct drainage were reported. The FV echoendoscope showed some unique advantages, opening new possibilities such as EUS-FNA in difficult gastrointestinal tracts and combined endoscopic/EUS treatment with frontal approach. However, no statistically significant evidence of superiority of the FV echoendoscope vs. the CLA echoendoscope was found in pancreatic pseudocyst drainage. No complications specifically attributable to the use of the FV echoendoscope were reported.
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Endoscopic ultrasound-guided fine needle aspiration: From the past to the future
Madalin-Ionut Costache, Sevastita Iordache, John Gásdal Karstensen, Adrian Saftoiu, Peter Vilmann
April-June 2013, 2(2):77-85
DOI
:10.4103/2303-9027.117691
PMID
:24949369
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a technique which allows the study of cells obtained through aspiration in different locations near the gastrointestinal tract. EUS-FNA is used to acquire tissue from mucosal/submucosal tumors, as well as peri-intestinal structures including lymph nodes, pancreas, adrenal gland, gallbladder, bile duct, liver, kidney, lung,
etc
. The pancreas and lymph nodes are still the most common organs targeted in EUS-FNA. The overall accuracy of EUS is superior to computed tomography scan and magnetic resonance imaging for detecting pancreatic lesions. In most cases it is possible to avoid unnecessary surgical interventions in advanced pancreatic cancer, and EUS is considered the preferred method for loco-regional staging of pancreatic cancer. FNA improved the sensitivity and specificity compared to EUS imaging alone in detection of malignant lymph nodes. The negative predictive value of EUS-FNA is relatively low. The presence of a cytopathologist during EUS-FNA improves the diagnostic yield, decreasing unsatisfactory samples or need for additional passes, and consequently the procedural time. The size of the needle is another factor that could modify the diagnostic accuracy of EUS-FNA. Even though the EUS-FNA technique started in early nineteen's, there are many remarkable progresses culminating nowadays with the discovery and performance of needle-based confocal laser endomicroscopy. Last, but not least, identification and quantification of potential molecular markers for pancreatic cancer on cellular samples obtained by EUS-FNA could be a promising approach for the diagnosis of solid pancreatic masses.
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ORIGINAL ARTICLES
Expression of vascular endothelial growth factor and epidermal growth factor receptor in pancreatic ductal adenocarcinomas, neuroendocrine tumours and chronic pancreatitis
Radu Angelescu, Florin Burada, Cristina Angelescu, Dan Ionut Gheonea, Sevastita Iordache, Francisc Mixich, Mihai Ioana, Adrian Saftoiu
April-June 2013, 2(2):86-91
DOI
:10.4103/2303-9027.117692
PMID
:24949370
Objective
: Angiogenesis is a crucial event for pancreatic carcinogenesis, and it also plays an important role in chronic pancreatitis. The aim of our study was to evaluate the mRNA expression of vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR) in chronic inflammatory or malignant pancreatic pathology in order to elucidate the differences in expression patterns and potential clinical implications.
Methods
: Thirty-five patients who had undergone endoscopic ultrasonography followed by endoscipic ultrasound-guided fine needle aspiration (EUS-FNA) of focal pancreatic masses were included in the study. VEGF and EGFR mRNA expression levels in the samples collected by EUS-FNA were analyzed using quantitative real-time polymerase chain reaction (PCR).
Results
: VEGF expression was detected in all chronic pancreatitis and adenocarcinoma samples and in only 62.5% of pancreatic neuroendocrine tumors. EGFR expression was detected in only 40% of the chronic pancreatitis cases, 76.9% of adenocarcinomas and in 50% of pancreatic neuroendocrine tumors. Both VEGF and EGFR mRNA levels were significantly higher in pancreatic ductal adenocarcinoma than those in normal tissue. VEGF expression inversely correlated with pancreatic ductal adenocarcinoma size, while EGFR expression was related to local invasiveness of adenocarcinoma.
Conclusion
: Both VEGF and EGFR mRNA expression in EUS-FNA samples may be used as a diagnostic marker associated with invasiveness in patients with pancreatic adenocarcinoma.
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Tuberculosis presenting as dysphagia: Clinical, endoscopic, radiological and endosonographic features
Surinder Singh Rana, Deepak Kumar Bhasin, Chalapathi Rao, Radhika Srinivasan, Kartar Singh
April-June 2013, 2(2):92-95
DOI
:10.4103/2303-9027.117693
PMID
:24949371
Objective
: Dysphagia as a presenting manifestation of tuberculosis is rare and there is paucity of data on the clinical, endoscopic and endosonographic features of these patients. We present our data related to the features over last four years.
Methods
: We analyzed retrospectively the clinical, endoscopic, radiological, endosonographic and cytological findings in 14 patients (male: 10; mean age: 37.7 ± 10.4 years) with dysphagia due to tuberculosis presenting to us over last 4 years.
Results
: Nine patients (64.3%) had Grade 1 dysphagia, 4 (28.6%) patients had Grade 2 and 1 patient (7.1%) had Grade 3. Mid esophagus was the commonest site of involvement. Endoscopic findings were extrinsic bulge (50%), linear ulcers (28.6%) and polypoidal ulcerated lesion (7.1%). Endoscopic biopsies were inconclusive. Endoscopic ultrasound (EUS) demonstrated mediastinal lymph nodes being responsible for endoscopic bulge and their infiltration into esophageal wall leading on to ulcers. EUS-guided fine needle aspiration from these nodes established diagnosis in all patients.
Conclusion
: Dysphagia in tuberculosis is most commonly caused by compression by the surrounding mediastinal lymph nodes. EUS is a useful investigation for assessment of these patients.
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REVIEWS
Role of endoscopic ultrasonography in the evaluation of extrahepatic cholangiocarcinoma
Anna Strongin, Harkirat Singh, Mohamad A Eloubeidi, Ali A Siddiqui
April-June 2013, 2(2):71-76
DOI
:10.4103/2303-9027.117690
PMID
:24949368
Cholangiocarcinoma is a malignancy that arises from biliary epithelium and is associated with a poor prognosis. Accurate preoperative diagnosis and staging of cholangiocarcinoma continues to remain difficult. Endoscopic retrograde cholangiopancreatography (ERCP) is the most commonly performed procedure for cholangiocarcinoma and can provide a tissue diagnosis through brush cytology of the bile duct. However, the sensitivity of biliary brush cytology to diagnose cholangiocarcinoma may be as low as 30%. Endoscopic ultrasound (EUS) is a diagnostic modality which may overcome the limitations of other imaging and biopsy techniques in this setting. EUS can complement the role of ERCP and provide a tissue diagnosis through fine needle aspiration (FNA) and staging through ultrasound imaging. There is currently a paucity of data about the exact role of EUS for the diagnosis of cholangiocarcinoma in patients with indeterminate extrahepatic biliary strictures. Although multiple studies have shown that EUS is more accurate than ERCP and radiologic imaging for identifying a biliary mass and diagnosing cholangiocarcinoma, the sensitivities are variable. More importantly, the incidence of false negative results is not negligible, though the specificity is close to 100%. There is also controversy regarding the role of EUS-FNA, since even though this may increase diagnosis, it can also lead to tumor seeding.
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IMAGE IN EUS
Gastric ulcer penetration into the liver mimicking malignancy on endoscopic ultrasound
Dimitrios Kypraios, Pietro Fusaroli, Stefano Artuso, Francesca Poli, Giancarlo Caletti
April-June 2013, 2(2):107-108
DOI
:10.4103/2303-9027.117700
PMID
:24949375
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ORIGINAL ARTICLES
Utility of narrow caliber echo-bronchoscope in pre-school pediatric population: A case series (with video)
Malay Sharma, Zeeshn Ahamad Wani, Raghav Bansal, Ruth Shifa Hari
April-June 2013, 2(2):96-101
DOI
:10.4103/2303-9027.117695
PMID
:24949372
The practical use of EUS in small children below the age of 4 years is not described. The aim of the study was to evaluate the feasibility, safety, and clinical utility of smaller caliber echo-bronchoscope in the management of gastrointestinal, pancreatobiliary, and mediastinal disease in children below 4 years. Consecutive children of age younger than 4 years where EUS was clinically considered useful were evaluated by echo-bronchoscopes. The findings showed that EUS by echo-bronchoscopes is feasible and safe in young children.
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EDITORIAL
Endoscopic ultrasound-guided biliary drainage
Everson L.A. Artifon
April-June 2013, 2(2):61-63
DOI
:10.4103/2303-9027.117687
PMID
:24949366
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CASE REPORTS
Mediastinal paraganglioma: Specific endoscopic ultrasound features
Shyam Sunder Sharma, Ashok Jhajharia, Sudhir Maharshi, Shewa Ram, Vijay Shankar, Prashant Katiar
April-June 2013, 2(2):105-106
DOI
:10.4103/2303-9027.117698
PMID
:24949374
Endoscopic ultrasound (EUS) features of mediastinal paraganglioma have not been described. In this paper, we report a female patient presented with cough and chest pain without any neuroendocrinal symptoms. Final diagnosis of mediastinal paraganglioma was made on thoracoscopic biopsy and immunohistochemistry after EUS-guided fine needle aspiration. EUS features of mediastinal paraganglioma are described.
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IMAGE IN EUS
Pancreatic metastasis from colon carcinoma diagnosed by endoscopic ultrasound fine needle aspiration
Augusto P.C Carbonari, Mauricio S Assef, Frank S Nakao, Aloisio S. F. da Silva, Luciane C do Valle, Dalton M Chaves
April-June 2013, 2(2):109-111
DOI
:10.4103/2303-9027.117701
PMID
:24949376
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CASE REPORTS
Role of EUS-FNA in recurrent lung cancer: Maximum results with minimum (minimally invasive) effort
Ana M Ioncica, Mehmet Bektas, Rei Suzuki, Adrian Saftoiu, Everson L.A. Artifon, Manoop S Bhutani
April-June 2013, 2(2):102-104
DOI
:10.4103/2303-9027.117696
PMID
:24949373
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an excellent method for primary lung cancer staging. We describe a 66-year-old male who underwent EUS-FNA for the diagnosis of recurrent lung cancer. Two years after initial radiation therapy followed by complete remission, routine follow-up imaging study revealed a mass in the right hilum. Trans-esophageal EUS revealed a 1.3-cm mass and the result of EUS-FNA was consistent with non-small lung cancer. EUS-FNA can play an important role in diagnosis of recurrent lung cancer as well as primary staging avoiding the more invasive diagnostic technique.
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LETTER TO THE EDITOR
Porcelain gall bladder on endoscopic ultrasound
Surinder S Rana, Deepak K Bhasin
April-June 2013, 2(2):112-113
DOI
:10.4103/2303-9027.117702
PMID
:24949377
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MEETING REPORT
Report of EURO-EUS 2013
Marc Giovannini, Paolo Arcidiacono, Erwin Santo, Julio Iglesias
April-June 2013, 2(2):114-116
DOI
:10.4103/2303-9027.117704
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Online since 20 August, 2013