Background. Endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI) are valuable tools in the assessment of cystic pancreatic lesions (CPLs). However, preoperative diagnosis of CPLs still remains a challenge. EUS-guided fine needle aspiration (FNA) provides a method to obtain cyst fluid for analysis to gain additional information. Aim. Compare the concordance between the diagnosis of the cyst by FNA, with that obtained by two diagnostic imaging methods (EUS morphology and MRI). Evaluate if EUS-FNA offered any benefit in cases of inconclusive MRI. Material and methods. We performed a retrospective analysis of a prospectively collected database at a tertiary-care academic medical center between January 2015 and December 2018. All patients who were referred for EUS were reviewed, and patients with diagnosis of pancreatic cysts were included. Imaging, pancreatic cyst fluid (PCF) and follow-up were analyzed. Results. A total of 2238 EUS were performed during the study period and 319 of them had a final diagnosis of pancreatic cyst. FNA was performed on 139 cysts: 62 were diagnosed as mucinous by PCF. The agreement between the diagnosis of the cyst by FNA, with that obtained by EUS morphology was 89.2% (Kappa 0.78, p < 0.001). The concordance between the diagnosis of the cyst by FNA and that obtained by MRI was 72.66 (Kappa 0.41, p < 0.001). From the 319 patients with pancreatic cysts, 60 (18.8%) had inconclusive results on MRI and EUS morphology was able to make a diagnosis in 31 of them. When we analyzed the 139 punctured cysts, MRI was indeterminate in 40 patients and FNA diagnosed 36 of the 40 patients (90%). Discussion. In our study, EUS +/- FNA was superior to MRI specially in cases of inconclusive MRI.
Balloon-assisted enteroscopy has proved to be effective in the diagnosis and treatment of small bowel lesions previously visualized by other methods. Few studies evaluate the usefulness of endoscopic capsule (EC) and non-invasive imaging studies preceding simple balloon enteroscopy (SBE). This work represents a contribution to a better understanding of the SBE in relation to the diagnostic yield as a second study and the existing coincidence between enteroscopy and the different preceding studies regarding lesions location. Material and methods. An analytical and observational study of a retrospective cohort of patients referred for SBE. Consecutive patients, who underwent SBE at the Hospital Italiano de Buenos Aires, were included between September 2010 and June 2017. Results. 140 SBE performed in 120 patients were analyzed. The access route was ante-grade in 91% of the studies. The most frequent indication was obscure gastrointestinal bleeding (41%). 50% of the patients had carried out an EC before the study, 27% had an enterotomography (ETC) or enteroresonance (ERMN) and 21% presented both studies. The overall diagnosis of lesions was 70%. The most frequent finding was angiodysplasias (46%) and was higher when the enteroscopy was preceded by CE compared with ETC or ERMN (76% vs. 61%; p = 0.06). The agreement between CE and ESB was moderate for the lesions diagnosis (Kappa 0.4194; p < 0.001) and good its localization (Kappa 0.6337; p < 0.001). Conclusions. SBE in our center is a procedure with a high diagnostic yield. This yield gets higher and the topographic agreement of the lesions is greater when it is carried out in a directed way after an EC.
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