Background: The diagnosis and management of cystic lesions of the pancreas is an increasingly recognized problem in clinical practice and many of the cystic pancreatic lesions are neoplastic and asymptomatic. Despite the significant advances occurred over the last decades, it remains difficulty to accurately distinguish between benign (serous cystic lesions) and malignant or potentially malignant (mucinous cystic lesions) pancreatic cysts before resecting them. Mucinous cystic neoplasms (MCNs), intrapapillary mucinous neoplasms (IPMN) and serous cystic neoplasms (SCNs) can display differences when examined by imaging modalities, endoscopic ultrasonography (EUS) and cytological and biochemical analyses of cyst fluid. The performance characteristics of high-resolution computed tomography (CT) scanning and magnetic resonance imaging (MRI) in making these distinctions are, however, disappointing. The aim of this study is to evaluate the role of endoscopic ultrasound guided fine needle aspiration (FNA) in diagnosis of cystic pancreatic lesions and its accuracy in discrimination between benign, malignant and potentially malignant cysts. Methods: The study was organized as a prospective study and conducted over 51 patients with identified cystic pancreatic lesions from prior radiological imaging (CT or MRI). Results: EUS guided FNA has shown superior sensitivity, specificity, positive predictive value and negative predictive value in comparison to EUS alone in discriminating mucinous from non-mucinous cysts. This difference was remarkable specially for malignant cysts (mucinous cystadenocarcinoma, adenocarcinoma) and cystic lymphangioma. EUS-FNA associated with chemical and physical analysis of cyst fluid was 100% sensitive and specific. Cyst fluid CEA revealed significant importance in differentiating mucinous from non mucinous cysts. Cyst fluid amylase was significantly high in pseudocysts while mucin stain was important to discriminate mucinous from non-mucinous cystic lesions. Conclusion: EUS-FNA has proven greater sensitivity and specificity, positive predictive, negative predictive value in differentiating mucinous and non-mucinous pancreatic cystic lesions as well as pathological categorization into subtypes.
Background and Objectives:Many gastrointestinal tumors as diffuse circumferential malignancies as signet ring cell carcinoma and lymphoma may involve mainly the submucosal layer and hence are difficult to diagnose as they frequently yield negative endoscopic biopsies. This main aim of this study is to evaluate the accuracy of endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) in the diagnosis of diffuse gastrointestinal (GI) lesions with inconclusive endoscopic biopsies.Patients and Methods:This prospective study included 102 patients with diffuse or circumferential GI lesions with nonconclusive biopsies that were taken during upper or lower endoscopy. EUS and EUS-FNA were performed to all patients with cytopathological examination.Results:This study included 65 males (64%) and 37 females (36%), with the mean age of 54.6 years; 80 cases (78.4%) were proved to have malignant lesions; 22 cases (21.6%) were proved to be benign. EUS had a sensitivity of 95%, specificity of 65%, positive predictive value (PPV) of 91%, negative predictive value (NPV) of 45% with P < 0.0001 in diagnosing malignant lesions. EUS-FNA had a sensitivity of 83%, specificity of 100%, PPV of 100%, NPV of 62%, with P < 0.0001.Conclusion:EUS with EUS-FNA is an accurate procedure in the diagnosis of endoscopic biopsy negative diffuse or circumferential GI lesions.
Background: Endoscopic ultrasonography (EUS) provides high-resolution images of the pancreas, and it is considered one of the most accurate methods for the diagnosis and staging of solid pancreatic lesions (SPL), EUS guided fine-needle aspiration (EUS–FNA) can obtain cytological samples of pancreatic lesions, making a pathologic diagnosis possible, however, it is associated with small, but not insignificant, morbidity. The aim of this work is to determine in a prospective study, the role of EUS in the diagnosis of SPL in comparison with different radiological studies and to determine the diagnostic value of EUS guided FNA and elastography in differentiation between benign and malignant pancreatic lesions. Patients and methods: A total of 50 patients with SPL identified by EUS after imaging studies were enrolled in the study. The qualitative elastography score was done, also the semi quantitative score of elastography was represented by the strain ratio (SR) method where two areas were selected, area (A) representing the region of interest and area (B) representing the normal area. Area (B) was then divided by area (A). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated by comparing diagnosis made by elastography, SR with the final diagnosis (by EUS-FNA, surgery, and/or follow up for 6 months). Results: SPL were found to be malignant in 38 patients and benign in 12 patients. SPL was diagnosed by different imaging modalities in 39 patients with a percentage of (78%), while it was diagnosed by EUS in all 50 patients with a percentage of (100%). Elastography score alone had a sensitivity of 89.4%, a specificity of 75%, a PPV of 91.8% and an NPV of 69.2% and an accuracy of 86%. The best cut-off level of SR to obtain the maximal area under the curve was 8.42 with a sensitivity of 92.1%, specificity of 83.3%, PPV of 94.6%, NPV of 76.9% and an accuracy of 93.1%. Adding both elastography score to SR resulted in a sensitivity of 94.7%, specificity of 83.3%, PPV of 94.7%, NPV of 83.3% and accuracy of 94.3% for the diagnosis of SPL. Conclusion: EUS has a role in diagnosis of SPL which may be superior to different radiological studies; also, EUS-elastography and SR can be a valuable complementary supplement for EUS-FNA.
Introduction: Portal hypertension is a common complication of liver cirrhosis. Varices are dilated collaterals that develop as a result of portal hypertension at the level of the porto-systemic connections and can cause a shift in the blood flow from high to low pressure. Common locations for porto-systemic shunts are the lower oesophagus and the gastric fundus. Ectopic varices are defined as dilated tortuous veins located at unusual sites other than the gastro-oesophageal junction.Aim: This research aimed to study the endoscopic assessment of ectopic varices as well as necessary haemostatic interventions to our best knowledge. Also, to perform a review of the literature to compare our results to the most recent available data.Material and methods: Our group extracted endoscopic reports of patients presenting to the emergency department with evidence of recent GI bleeding in whom ectopic varices were identified. We reported all interventions or procedures needed, details of hospitalization, radiological and laboratory results, as well as follow-up charts.Results: Our study included 95 patients presenting to the emergency department with evidence of active GI bleeding. Ectopic varices were identified as the source of bleeding in 28 cases. Bleeding from duodenal varices was found in 17 patients and rectal varices in 9 patients. Endoscopic management was used for all cases with active bleeding. Rebleeding from ectopic varices was found in 5 cases, for whom interventional radiology was performed. All cases with rebleeding were duodenal varices. Early mortality occurred in 3 cases after re-intervention.Conclusions: Our study describes a series of patients with ectopic varices discovered upon emergency endoscopy. Rectal varices were the most commonly found in our series. Bleeding and the need for re-intervention is more common in duodenal varices.
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