Background/Aims: Endoscopic ultrasound-guided liver biopsy (EUS-LB) is an effective and safe method of procuring liver tissue. The aims of this study were to assess and compare the outcomes and tissue adequacy of a single-pass, single-actuation, wet suction technique between 19 G and 22 G needles in patients undergoing EUS-LB.Methods: We performed a prospective case series study of 20 patients undergoing EUS-LB at a single center between September 2017 and April 2020. The primary objective was to evaluate differences in sample adequacy via a single actuation wet suction technique between a 19 G core needle and a 22 G core needle. Adequacy was gauged by cumulative core biopsy length and the number of portal tracts visualized.Results: The 19 G needle provided a longer core length (2.5 cm vs. 1.2 cm, p<0.0001), more complete portal tracts (5.8 vs. 1.7, p<0.0001), more total tracts (8.8 vs. 3, p<0.0001), and a longer, intact, fragment length (0.75 cm vs. 0.32 cm, p<0.0006). The 19 G needle was superior in providing adequate (60% vs. 5%, p<0.001) and diagnostic pathologic samples (85% vs. 10%, p<0.001).Conclusions: A single-pass, single-actuation, wet suction technique using a 19 G needle is superior to that using a 22 G needle for tissue acquisition and sample adequacy in EUS-LB.
Endoscopic retrograde cholangiopancreatography (ERCP) is the primary therapeutic intervention for pancreaticobiliary duct diseases. Surgically altered anatomy (SAA) makes performing successful ERCP challenging. In this review article the concept of endoscopic ultrasound guided pancreaticobiliary drainage (EUS-PBD) in cases of SAA where conventional ERCP fails or is not possible will be reviewed. EUS-PBD serves as an emerging and promising alternative for pancreaticobiliary therapy in the hands of skilled endoscopists compared to conventional therapies such as device-assisted ERCP, laparoscopic-assisted ERCP, or percutaneous drainage. The purpose of this review is to discuss the rationale, technique and current published outcomes on EUS-PBD for SAA.
Background: A previous study of patients with unresectable hepatocellular carcinoma (HCC) was extended to further examine factors associated with overall survival (OS) after selective internal radiation therapy with yttrium-90 resin microspheres (Y90 SIRT).Methods: Data from patients of any age diagnosed with unresectable HCC and treated with Y90 SIRT at our institution from 2004 through 2017 were retrospectively analyzed. Among other criteria, patients had to have Eastern Cooperative Oncology Group performance status 0 to 2, not have received Y90 SIRT previously, and not have extrahepatic disease. Primary outcome was OS; secondary outcomes included tumor response and adverse events (AEs). Kaplan-Meier survival analyses and multivariable Cox proportional hazards models were used to evaluate prognostic factors for OS.Results: Of the 226 patients, 59% were White, 77% were male, and the mean age at first SIRT procedure was 65.1±9.4 years. More than half had received previous treatment for HCC. The most common etiology was hepatitis C (n=138/224 available, 62%), followed by alcohol use (n=45, 20%), and nonalcoholic steatohepatitis (n=27, 12%). The mean model for end-stage liver disease score at baseline was 8.8±2.2. Patients were followedup for a median of 12.2 months (95% CI, 0.0-62.6). Median OS was 16.6 months (95% CI, 13.1 to not reached). Bilobar disease, higher albumin-bilirubin score at baseline, prior treatment with sorafenib, alcohol use etiology, and higher administered dose were associated with shorter survival, whereas subsequent liver transplant [in 26 patients (11.5%)] was associated with longer survival. Of the 186 patients with AEs data, 75 (40.3%) patients reported an event and, of these, 13 (17.3%) patients had grade 4 bilirubin values.Conclusions: In a large, diverse population treated at a single center over 13 years, Y90 SIRT produced a median OS of 16.6 months in patients with unresectable HCC and enabled subsequent transplantation in a subset of patients. Factors affecting the length of survival should be considered when making treatment decisions for unresectable HCC.
INTRODUCTION: Screening colonoscopy is an integral but underutilized diagnostic tool in preventing colorectal cancer (CRC). Reasons for delays in CRC screening include incorrect referrals, shortage of physician availability and endoscopy capacity, and limited access to care for uninsured and minority patients. The aims of our study were to measure the time from referral to screening colonoscopy and to define predictors of noncompliance to CRC screening. METHODS: A retrospective chart review of patients referred to our clinic for screening colonoscopy was conducted from 7/2017 to 9/2018. Inclusion criteria were age appropriate CRC screening; patients with positive FOBT/FIT for purely screening reasons were also included. Patients younger than 45 or older than 85 years, or those referred for a diagnostic (evaluation of anemia, hematochezia, weight loss) or surveillance colonoscopy (prior adenomatous polyps or adenocarcinoma) were excluded. Patient demographics, referral data, and medical histories were reviewed. RESULTS: 180 patients met inclusion criteria. Follow-up throughput is shown in Figure 1. 63% patients were deemed non-compliant (not making an appointment, missing scheduled appointment, or not completing recommended colonoscopy). Appointments for 60% of patients were canceled because of missed pre-GI visit registration or patient no showed. 52% of referrals came from outside the health system. 53% of all patients referred were never seen by GI. 71% of patients ordered to have a screening colonoscopy completed their procedure. A final total of 28% of all patients referred eventually underwent colonoscopy.Non-compliant patients were more likely to be uninsured (P-value = 0.04), come from outside referral (P-value = 0.014), have more days from referral reviewed to appointment (81.8 vs 71 days, P value = 0.01), and have less medical problems (1.2 vs 1.5, P value = 0.04). There was no statistical difference between gender, age, race, Hispanic, language, marital status, tobacco use, Charlson Comorbidity Score, or days from clinic appointment to colonoscopy. CONCLUSION: Our study identified outside referrals, lack of insurance, and more days from referral received to appointment as predictors of non-compliance to screening colonoscopy.Further interventions should address optimization of utilization of screening colonoscopies, such as targeted navigational resources for uninsured patients from outside referrals, minimizing steps to GI clinic visit, and educating patients on the value of CRC screening.
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