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2013| October-December | Volume 2 | Issue 4
Online since
November 15, 2013
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ORIGINAL ARTICLES
Endoscopic ultrasound-guided drainage of pancreatic pseudocysts: Medium-term assessment of outcomes and complications
Pui Yung Ng, Ditlev Nytoft Rasmussen, Peter Vilmann, Hassem Hassan, Victor Gheorman, Daniela Burtea, Valeriu Surlin, Adrian Saftoiu
October-December 2013, 2(4):199-203
DOI
:10.4103/2303-9027.121245
PMID
:24949396
Objective:
Endoscopic ultrasound (EUS)-guided drainage is a widely used treatment modality for pancreatic pseudocysts (PPC). However, data on the clinical outcome and complication rates are conflicting. Our study aims to evaluate the rates of technical success, treatment success and complications of EUS-guided PPC drainage in a medium-term follow-up of 45 weeks.
Materials and Methods:
A retrospective review was conducted for 55 patients with symptomatic PPC from December 2005 to August 2010 drained by EUS. Medium-term follow-up data were obtained by searching their medical history or by telephonic interview.
Results:
A total of 61 procedures were performed. The symptoms that indicated drainage were abdominal pain (
n
= 43), vomiting (
n
= 7) and jaundice (
n
= 5). The procedure was technically successful in 57 of the 61 procedures (93%). The immediate complication rate was 5%. At a mean follow-up of 45 weeks, the treatment success was 75%. The medium term complications appeared in 25% of cases, which included three cases each of stent clogging, stent migration, infection and six cases of recurrence. There was no mortality.
Conclusion:
EUS-guided drainage is an effective treatment for PPC with a successful outcome in most of patients. Most of the complications require minimal invasive surgical treatment or repeated EUS-guided drainage procedures.
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Endoscopic ultrasound-guided fine needle aspiration versus percutaneous ultrasound-guided fine needle aspiration in diagnosis of focal pancreatic masses
Hussein Hassan Okasha, Mazen Ibrahim Naga, Serag Esmat, Mohamed Naguib, Mohamed Hassanein, Mohamed Hassani, Mohamed El-Kassas, Reem Ezzat Mahdy, Emad El-Gemeie, Ali Hassan Farag, Ayman Mohamed Foda
October-December 2013, 2(4):190-193
DOI
:10.4103/2303-9027.121239
PMID
:24949394
Objective:
Pancreatic carcinoma is one of the leading cancer morbidity and mortality world-wide. Controversy has arisen about whether the percutaneous approach with computed tomography/ultrasonography-guidance fine needle aspiration (US-FNA) or endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the preferred method to obtain diagnostic tissue. Our purpose of this study is to compare between the diagnostic accuracy of EUS-FNA and percutaneous US-FNA in diagnosis of pancreatic cancer.
Patients and Methods:
A total of 197 patients with pancreatic masses were included in the study, 125 patients underwent US-FNA (Group 1) and 72 patients underwent EUS-FNA (Group 2).
Results:
EUS-FNA has nearly the same accuracy (88.9%) as US-FNA (87.2%) in diagnosis of pancreatic cancer. The sensitivity, specificity, positive predictive value and negative predictive value for EUS-FNA was 84%, 100%, 100%, 73.3% respectively. It was 85.5%, 90.4%, 94.7%, 76% respectively for US-FNA. EUS-FNA had a lower complication rate (1.38%) than US-FNA (5.6%).
Conclusion:
EUS-FNA has nearly the same accuracy as US-FNA of pancreatic masses with a lower complication rate.
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REVIEW
Role of endoscopic ultrasound in treatment of pancreatic cancer
Xiaozhong Guo, Zhongmin Cui, Zhigang Hu
October-December 2013, 2(4):181-189
DOI
:10.4103/2303-9027.121238
PMID
:24949393
Endoscopic ultrasound (EUS) can help diagnose diseases with high accuracy because it overcomes the limitations of gastrointestinal gas and abdominal fat. The emergence of curved linear-array echoendoscopy has significantly promoted the applications of the technique to new levels. The advancement has appeared from EUS imaging to EUS-guided fine needle aspiration, drainage and injection. Computed tomography and magnetic resonance imaging present certain limitations for diagnosing pancreatic tumors due to the specificity of the location of such growths. In addition, traditional chemotherapy does not show ideal results because pancreatic cancer (PC) exhibits hypovascular characteristics. Interventional EUS can overcome these limitations and has potential to become the mainstream method of PC local treatment in the future. This paper reviews the use of interventional EUS in the treatment of PC based on previous studies.
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ORIGINAL ARTICLES
Pancreato-biliary endoscopic ultrasound in opium addicts presenting with abdominal pain
Shyam Sundar Sharma, Seva Ram, Sudhir Maharshi, Vijay Shankar, Prashant Katiyar, Ashok Jhajharia, Vimal Sardava, Hemendra Bhardwaj
October-December 2013, 2(4):204-207
DOI
:10.4103/2303-9027.121247
PMID
:24949397
Objective:
Asymptomatic dilatation of bile duct and symptomatic sphincter of Oddi dysfunction have been reported in opium addicts. Except one case report, there is no report in the literature on endoscopic ultrasound (EUS) study of pancreato-biliary system in opium addicts. The aim of the present study was to report the EUS features of pancreato-biliary system in opium addicts presenting with abdominal pain.
Patients and Methods:
A total of 15 opium addicts presenting with upper abdominal pain and dilated common bile duct (CBD) and or pancreatic duct (PD) on abdominal ultrasound were included in this study. EUS findings of pancreato-biliary system were analyzed in these patients.
Results:
All the 15 patients were males (mean age 53.3 years) presented with upper abdominal pain. Mean duration of opium addiction was 20.1 years. On EUS CBD was dilated in all the patients while PD was dilated in six patients. Gall bladder, liver and pancreatic parenchyma was normal in all these patients. Surface area of papilla of Vater (SPV) was increased in 12 patients.
Conclusion:
Opium addiction causes obstruction at ampulla and produces dilatation of bile duct and PD. Bile duct dilatation was seen in all the patients while PD dilatation was seen in few patients. Increase in SPV was a peculiar finding and appears to be as a result of direct effect of opium on ampulla.
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MEETING REPORT
Role of endoscopic ultrasound in the management of digestive system disease: Proceedings of 2013 asian pacific digestive week meeting
Xiujing Sun, Qiang He, Youqing Xu
October-December 2013, 2(4):230-232
DOI
:10.4103/2303-9027.121242
Endoscopic ultrasound (EUS) was one of the important topics in 2013 Asian Pacific Digestive Week Meeting and some new progresses were highlighted. The global burdens of pancreatic diseases and biliary diseases are increasing. EUS is becoming a fundamental tool for this cohort of patients, because of not only its ability to provide superior visualization of the lesions, but also its ever-improving interventional capacity. Meanwhile, EUS may also help to diagnose and treat the gastrointestinal tract diseases
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ORIGINAL ARTICLES
Intramural pseudocysts of the upper gastrointestinal tract
Surinder Singh Rana, Deepak Kumar Bhasin, Chalapathi Rao, Rajesh Gupta
October-December 2013, 2(4):194-198
DOI
:10.4103/2303-9027.121240
PMID
:24949395
Background:
Intramural pseudocysts or pseudocysts occurring in the gastrointestinal tract (GIT) wall are rare and there is a paucity of data on their clinical features and management.
Patients and Methods:
We retrospectively evaluated patients with intramural pseudocysts seen at our institution over the past 6 years. Intramural location was confirmed either on surgery or endoscopic ultrasound (EUS). Depending upon the symptoms, their control with the conservative medical therapy and procedural consent, the patients underwent EUS guided single time aspiration of the pseudocyst or transmural drainage or transpapillary drainage or surgery.
Results:
A total of 9 patients with intra mural pseudocysts (male:
n
= 8; mean age ± SD: 39.3 ± 8.0 years; age range: 24-54 years; five patients having chronic and four patients having acute pancreatitis) were studied. The pseudocysts were located in the wall of the second part of the duodenum in five patients, in the gastric wall in three patients and in the lower esophageal wall in one patient. The size of the pseudocysts ranged from 8 mm to 8 cm and 3/9 (33%) patients had associated extra mural pancreatic pseudocysts. All patients had abdominal pain on presentation. Along with pain the patients with duodenal intramural pseduocysts also had symptoms suggestive of gastric outlet obstruction (3) or jaundice (1). The patient with esophageal intramural pseudocyst had dysphagia along with abdominal pain. Majority of these patients could be successfully treated endoscopically with no significant complications.
Conclusions:
Intramural pseudocysts of the upper GIT are very rare and EUS is a useful investigational modality for diagnosing and treating them.
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CASE REPORTS
Uterine cervical cancer metastases to mediastinal lymph nodes diagnosed by endoscopic ultrasound-guided fine needle aspiration
Somashekar G Krishna, Yezaz A Ghouri, Rei Suzuki, Manoop S Bhutani
October-December 2013, 2(4):219-221
DOI
:10.4103/2303-9027.121250
PMID
:24949399
Utility of endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) for diagnosis of metastatic mediastinal lymph node (MLN) following an unproductive computed tomography (CT) guided-biopsy in a patient with cervical cancer. A 35-year-old woman with locally invasive cervical cancer was found to have a suspicious paraesophageal posterior MLN during the preliminary staging. Mediastinal metastasis from cervical cancer has been rarely reported. Mediastinal CT-guided-biopsy was non-diagnostic. Hence, patient underwent EUS guided-FNA of MLN confirming metastatic cervical cancer. Cervical cancer metastasis to MLN is rare. EUS can be safely and effectively used for FNA from paraesophageal lymph nodes.
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272
Solitary pancreatic metastasis from renal cell carcinoma 6 years after nephrectomy
Hussein Hassan Okasha, Emad Hamza Al-Gemeie, Reem Ezzat Mahdy
October-December 2013, 2(4):222-224
DOI
:10.4103/2303-9027.121248
PMID
:24949400
Metastatic cancer to the pancreas is rare and accounts for less than 2% of all pancreatic malignancies. Renal cell cancer, malignant melanoma, lung, colon and breast carcinoma are among the few tumors known to metastasize to the pancreas. The pancreas is a rare site of solitary metastasis, but it is often involved in diffuse metastatic disease. We report a case of a female patient with a solitary mass in the neck of the pancreas following right nephrectomy performed 6 years previously for renal cell carcinoma (RCC). An endoscopic ultrasound (EUS) revealed a well-defined lesion in the neck of the pancreas. Patient underwent EUS-guided fine-needle aspiration and cytopathology confirmed the diagnosis of a metastatic RCC. Solitary pancreatic metachronous metastasis from RCC may rarely occur. The interval between nephrectomy and pancreatic metastasis may be long.
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Diagnosis of hydatid cyto-biliary disease by intraductal ultrasound (with video)
Randa Akel, Walid Faraj, Ali Haydar, Omar Masri, Nadim El-Majzoub, Mohamad J Khalife, Mohamad A Eloubeidi
October-December 2013, 2(4):225-227
DOI
:10.4103/2303-9027.121246
PMID
:24949401
Hydatid disease is one of the relatively common infections in the Middle Eastern countries. It is seen in areas where dogs are used to raise livestock. In humans, the majority of
Echinococcus
cysts tends to develop in the liver (70%) and is asymptomatic. The two most common complications of hydatid cysts are abscess formation and rupture. Furthermore, in 5-25% of patients, rupture occurs into the biliary tract and patients may present with cholangitis, jaundice, abscess, or bilio-cutaneous fistula after surgery. Intraductal ultrasound (IDUS) is reportedly superior to conventional endoscopic ultrasound for the depiction of bile duct obstruction owing to its additional capability of providing higher resolution images due to the use of higher frequency transducers. Unfortunately IDUS is rarely used, possibly due to the limited availability of appropriate IDUS equipment, cost of the procedure and interventional endoscopists trained in its interpretation. IDUS with wire-guided, thin-caliber, high-frequency probes is a promising imaging modality, yet no previous reports discuss its usefulness in hydatid disease investigation. We hereby present the first report of biliary hydatid disease being diagnosed by IDUS.
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EDITORIAL
Endobronchial ultrasound: First choice for the mediastinum
Felix J. F. Herth
October-December 2013, 2(4):179-180
DOI
:10.4103/2303-9027.121235
PMID
:24949392
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IMAGE IN EUS
Portal hypertensive biliopathy developing after acute severe pancreatitis
Surinder Singh Rana, Deepak Kumar Bhasin, Chalapathi Rao, Kartar Singh
October-December 2013, 2(4):228-229
DOI
:10.4103/2303-9027.121244
PMID
:24949402
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ORIGINAL ARTICLES
Endoscopic ultrasound practice survey in latin America
Juliana Marques Drigo, Cecilia Castillo, Wallia Wever, José Ricardo Ruíz Obaldía, Sheila Fillipi, Manoel C. S. A. Ribeiro, Lucio G.B. Rossini
October-December 2013, 2(4):208-218
DOI
:10.4103/2303-9027.121251
PMID
:24949398
Objective:
Endoscopic ultrasound (EUS) has become an important imaging modality for the diagnosis, staging and treatment of gastrointestinal disorders. However, no official data exists regarding clinical EUS practice in Latin America (LA). This study assessed current EUS practice and training.
Patients and Methods:
A direct mail survey questionnaire was sent to 268 Capνtulo Latino Americano de Ultrasonido Endoscópico members between August 2012 and January 2013. The questionnaire was sent out in English, Spanish and Portuguese languages and was available through the following site: http://www.cleus-encuesta.com. Responses were requested only from physicians who perform EUS.
Results:
A total of 70 LA physicians answered the questionnaire until January 2013. Most of the participants were under 42 years of age (53%) and 80% were men. Most participants (45.7%) perform EUS in Brazil, 53% work in a private hospital. The majority (70%) also perform endoscopic retrograde cholangiopancreatography. A total 42% had performed EUS for 2 years or less and 22.7% for 11 years or more. Only 10% performed more than 5000 EUS. The most common indication was an evaluation of pancreatic-biliary-ampullary lesions. Regarding training, 48.6% had more than 6 months of dedicated hands-on EUS and 37% think that at least 6 months of formal training is necessary to acquire competence. Furthermore, 64% think that more than 50 procedures for pancreatic-biliary lesions are necessary.
Conclusion:
This survey provides insight into the status of EUS in LA. EUS is performed mostly by young endoscopists in LA. Diagnostic upper EUS is the most common EUS procedure. Most endosonographers believe that formal training is necessary to acquire competence.
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Online since 20 August, 2013