Background and Objectives:There is no consensus about the ideal method for diagnosis in patients who have already undergone endoscopic ultrasound fine needle aspiration (EUS-FNA), and the inconclusive material is often obtained. The aim was to evaluate the diagnostic yield of the second EUS-FNA of pancreatic lesions.Materials and Methods:A retrospective analysis of prospectively collected data of patients with EUS-FNA of pancreatic lesions is performed. All patients who underwent more than one EUS-FNA for the evaluation of suspected pancreatic cancer over a 7-year period were included in the analysis.Results:A total of 296 EUS-FNAs of the pancreas were performed in 257 patients. The diagnostic yield with the first EUS-FNA was 78.6% (202/257). Thirty-nine (13.3%) FNAs were repeated in 34 patients; 17 (50%) patients were women. The mean ± standard deviation (SD) age was 58.8 ± 16.1 years. The location of the lesions in the pancreatic gland, from which the second biopsies were taken, was head of the pancreas, n = 28 (82.4%), body of the pancreas, n = 3 (8.8%), and tail, n = 3 (8.8%). The mean ± SD of the size of the lesion was 36.3 ± 14.6 mm. The second EUS-FNA was more likely to be positive for diagnosis in patients with an “atypical“ histological result in the first EUS-FNA (odds ratio [OR]: 4.04; 95% confidence interval [CI]: 0.9–18.3), in contrast to patients with a first EUS-FNA reported as “normal” (OR: 0.21; 95% CI: 0.06–0.71). Overall, the diagnostic yield of the second EUS-FNA was 58.8% (20/34) with an increase to 86.3% overall (222/257).Conclusion:Repeat EUS-FNA in pancreatic lesions is necessary in patients with a negative first EUS-FNA because it improves the diagnostic yield.
The frequency of Barrett's esophagus was 9.6 cases for every 1,000 upper gastrointestinal endoscopies performed. Dysplasia was not documented in the majority of the patients with Barrett's esophagus and they had no histopathologic changes during follow-up. A total of 19.3% of the patients presented with dysplasia or cancer.
A 70-year-old man underwent screening colonoscopy which revealed a nonspecific colitis characterized by several areas of "patchy" erythema (• " Fig. 1), congestion, and subepithelial hemorrhage of the mucosa of the left colon. Surprisingly, many dead insects resembling small cockroaches were seen (• " Fig. 2). These insects corresponded to the species Ulomoides dermestoides, colloquially known as "Chinese weevils." They were present in larval and adult stages, and some adult insects were undigested and appeared to be "alive" (• " Fig. 3). After the procedure, the patient informed us that he had consumed these bugs as part of an alternative therapy known as "coleotherapy," which consists of the consumption of live Chinese weevils over a period of 140 days. This alternative therapy is purportedly useful in combating diseases such as "any type" cancer, asthma, psoriasis, diabetes, vitiligo, chronic skin diseases, arthritis, Parkinson's disease, and depression. In a review of the subject, the word "coleotherapy" provided no results in PubMed; however there were recent publications that reported a cytotoxic effect and DNA damage to cellular components of epithelial cell line A549 human lung carcinoma by these insects, and decreased total leukocytes, polymorphonuclear leukocytes, and total proteins in an animal model for pleural damage with carrageenan after applying an "aqueous substrate" of these insects [1, 2]. At the present time, there is no firm scientific evidence to justify the use of this alternative therapy. We suspect that the mucosal colonic inflammation was the result of the presence of the dead insects.
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