RESUMEN
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an alternative approach to sample kidney lesions that is less commonly used compared to percutaneous CT or ultrasound guidance. In this case, we present a 70-year-old female who was diagnosed with metastatic renal cell carcinoma (RCC) 18 years post-nephrectomy with EUS-FNA in conjunction with immunohistochemistry. This case report supports the use of EUS-FNA in conjunction with immunohistochemistry as a robust technique that can safely and effectively diagnose recurrent renal cell carcinoma.
RESUMEN
BACKGROUND: Acute pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP). The aim of this noninferiority study was to evaluate the effectiveness of pancreatic duct (PD) stenting plus pharmacological prophylaxis vs. pharmacological prophylaxis alone in the prevention of post-ERCP pancreatitis (PEP) in high risk patients. METHODS: In this randomized, controlled, double-blind, noninferiority trial, patients at high risk of developing PEP were randomly allocated to pharmacological prophylaxis (rectal indomethacin, sublingual isosorbide dinitrate, and intravenous hydration with Ringer's lactate) plus PD stenting (group A) or pharmacological prophylaxis alone (group B). The rate and severity of PEP, serum amylase levels, and length of hospital stay after ERCP were assessed. RESULTS: During 21 months, a total of 414 patients (mean age 55.5â±â17.0 years; 60.2â% female) were enrolled (207 in each group). PEP occurred in 59 patients (14.3â%, 95â% confidence interval [CI] 11.1â%â-â17.9â%: 26 patients [12.6â%, 95â%CI 8.6â%â-â17.6â%] in group A and 33 [15.9â%, 95â%CI 11.4â%â-â21.4â%] in group B). There was no significant difference between the two groups in PEP severity (Pâ=â0.59), amylase levels after 2 hours (Pâ=â0.31) or 24 hours (Pâ=â0.08), and length of hospital stay (Pâ=â0.07). CONCLUSIONS: The study failed to demonstrate noninferiority or inferiority of pharmacological prophylaxis alone compared with PD stenting plus pharmacological prophylaxis in the prevention of PEP in high risk patients.
Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Indometacina/uso terapéutico , Conductos Pancreáticos/cirugía , Pancreatitis/prevención & control , Stents , Adulto , Anciano , Método Doble Ciego , Femenino , Humanos , Dinitrato de Isosorbide/uso terapéutico , Masculino , Persona de Mediana Edad , Pancreatitis/etiología , Vasodilatadores/uso terapéuticoAsunto(s)
Endoscopía Gastrointestinal , Neoplasias Gastrointestinales/diagnóstico por imagen , Neoplasias Gastrointestinales/cirugía , Tumores del Estroma Gastrointestinal/diagnóstico por imagen , Leiomioma/diagnóstico por imagen , Tumores Neuroendocrinos/diagnóstico por imagen , Algoritmos , Coristoma/diagnóstico por imagen , Resección Endoscópica de la Mucosa , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/instrumentación , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/métodos , Endosonografía , Tumores del Estroma Gastrointestinal/patología , Tumores del Estroma Gastrointestinal/cirugía , Tumor de Células Granulares/diagnóstico por imagen , Humanos , Leiomioma/cirugía , Lipoma/diagnóstico por imagen , Lipoma/cirugía , Tumores Neuroendocrinos/cirugía , PáncreasAsunto(s)
Enfermedades Duodenales/diagnóstico por imagen , Endoscopía Gastrointestinal , Hemorragia Gastrointestinal/diagnóstico por imagen , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Yeyuno/diagnóstico por imagen , Anemia Ferropénica/etiología , Angiografía , Enteroscopia de Balón , Endoscopía Capsular , Colonoscopía , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Humanos , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos XAsunto(s)
Profilaxis Antibiótica , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colangitis/etiología , Colecistitis/etiología , Hemorragia/etiología , Perforación Intestinal/etiología , Pancreatitis/etiología , Colangitis/microbiología , Colangitis/prevención & control , Colecistitis/microbiología , Colecistitis/prevención & control , Duodenoscopios/microbiología , Embolia Aérea/etiología , Hemorragia/prevención & control , Hemorragia/terapia , Humanos , Perforación Intestinal/terapia , Pancreatitis/diagnóstico , Pancreatitis/prevención & control , Factores de Riesgo , Esfinterotomía Endoscópica/efectos adversosRESUMEN
BACKGROUND: Referral for endosonographic evaluation of subepithelial lesions seen in the gastrointestinal (GI) tract is fairly common. Although rarely studied separately in details, esophageal lesions have some unique differences from other GI sites and might deserve some special considerations regarding follow-up and management. MATERIALS AND METHODS: All cases referred for endoscopic ultrasound (EUS) evaluation of subepithelial esophageal lesions at Bezmialem University Hospital, a tertiary center in Istanbul, Turkey were retrospectively reviewed. Data were collected for patient and lesion characteristics as well as for pathology results and follow-up if available. Lesions were subcategorized according to their size, location, and final diagnosis. RESULTS: A total of 164 EUS examinations were identified. In 22.5% of cases, the lesion could not be identified by EUS. Of the remaining cases, 57.6% had a lesion larger than 1 cm in size. Extramural compression was the diagnosis in 12% and leiomyoma in around 60%. Thirteen patients had follow-up examinations with only two showing an increase in size after 12 months. Sixty-five EUS-guided fine needle aspirations (EUS-guided FNAs) were performed, with around 50% having nondiagnostic samples and 94% of the remaining samples confirming the presumptive diagnosis. CONCLUSIONS: The majority of subepithelial lesions in the esophagus are benign with extremely low malignancy potential. EUS examinations performed for lesions smaller than 2 cm as well as FNAs taken from lesions smaller than 3 cm might have minimal impact on their ultimate management and outcome. More than one FNA pass should be attempted in order to improve the yield.
Asunto(s)
Carcinoma Ductal Pancreático/diagnóstico , Neoplasias Quísticas, Mucinosas y Serosas/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Técnicas de Ablación , Antineoplásicos/uso terapéutico , Antígeno Carcinoembrionario/metabolismo , Carcinoma Ductal Pancreático/metabolismo , Carcinoma Ductal Pancreático/patología , Carcinoma Ductal Pancreático/terapia , Colangiopancreatografia Retrógrada Endoscópica , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Endosonografía , Etanol/uso terapéutico , Humanos , Inyecciones Intralesiones , Neoplasias Quísticas, Mucinosas y Serosas/metabolismo , Neoplasias Quísticas, Mucinosas y Serosas/patología , Neoplasias Quísticas, Mucinosas y Serosas/terapia , Paclitaxel/uso terapéutico , Neoplasias Pancreáticas/metabolismo , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/terapia , Solventes/uso terapéuticoRESUMEN
Treatment of choledocholithiasis and cholelithiasis in patients with cirrhosis often requires diagnostic and therapeutic endoscopy such as endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). Patients with underlying cirrhosis may have coagulopathy, hepatic encephalopathy, ascites and other comorbidities associated with cirrhosis that can make endoscopic therapy challenging and can be associated with a higher risk of adverse events. Given the unique derangements of physiologic parameters associated with cirrhosis this population requires a truly multifaceted and multidisciplinary understanding between therapeutic endoscopists, hepatologists and anesthesiologists. For therapeutic endoscopists, it is critical to be aware of the specific issues unique to this population of patients to optimize outcomes and avoid adverse events. The epidemiology of gallstone disease, the diagnostic and therapeutic approach to patients with varying degree of hepatic dysfunction, and a review of the available literature in this area are presented.
Asunto(s)
Colangiopancreatografia Retrógrada Endoscópica , Coledocolitiasis/terapia , Colelitiasis/terapia , Cirrosis Hepática/complicaciones , Esfinterotomía Endoscópica , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Pancreatocolangiografía por Resonancia Magnética , Colecistectomía , Coledocolitiasis/complicaciones , Coledocolitiasis/diagnóstico por imagen , Colelitiasis/complicaciones , Colelitiasis/diagnóstico por imagen , Endosonografía , Humanos , Hipnóticos y Sedantes/efectos adversos , Hipnóticos y Sedantes/farmacocinética , Cirrosis Hepática/diagnóstico , Complicaciones Posoperatorias/etiología , Valor Predictivo de las Pruebas , Factores de Riesgo , Esfinterotomía Endoscópica/efectos adversos , Resultado del TratamientoAsunto(s)
Anticoagulantes/uso terapéutico , Pérdida de Sangre Quirúrgica/prevención & control , Endoscopía Gastrointestinal/métodos , Fibrinolíticos/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Hemorragia Posoperatoria/prevención & control , Anticoagulantes/efectos adversos , Fibrinolíticos/efectos adversos , Humanos , Inhibidores de Agregación Plaquetaria/efectos adversos , Hemorragia Posoperatoria/inducido químicamenteAsunto(s)
Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Enfermedad de Hodgkin/diagnóstico por imagen , Enfermedad de Hodgkin/patología , Páncreas/patología , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/patología , Adulto , Endosonografía , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND AND AIMS: EUS-guided FNA (EUS-FNA) is increasingly being used for tissue diagnosis of extrahepatic biliary strictures. The aim of this study was to determine the diagnostic yield of EUS-FNA in malignant biliary strictures. METHODS: A comprehensive literature review was carried out by 2 reviewers for studies evaluating the accuracy of EUS-FNA in biliary stricture. A meta-analysis was performed to determine the pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio for EUS-FNA of extrahepatic biliary stricture. A Quality Assessment of Diagnostic Accuracy Studies questionnaire was used to assess the quality of the selected studies. Several sensitivity analyses were performed to assess the effect of the quality of the studies on the accuracy of the final results of the meta-analysis. RESULTS: Twenty studies involving 957 patients met inclusion criteria and were included in the meta-analysis. The pooled sensitivity and specificity of EUS-FNA for diagnosis of malignant biliary stricture were 80% (95% confidence interval [CI], 74%-86%), and 97% (95% CI, 94%-99%), respectively. The pooled positive likelihood ratio was 12.35 (95% CI, 7.37-20.72), and the negative likelihood ratio was 0.26 (95% CI, 0.18-0.38). The pooled diagnostic odds ratio for diagnosing a malignant biliary stricture was 70.53 (95% CI, 38.62-128.82). The area under the receiver-operating characteristic curve was 0.97. Sensitivity analyses showed that the quality of the included studies did not affect the accuracy of the final results of the meta-analysis. CONCLUSION: This meta-analysis demonstrates that EUS-FNA is sensitive and highly specific for diagnosing malignancy in biliary strictures. Further studies are needed to compare EUS--FNA with emerging methods including cholangioscopy-guided biopsy and laser endomicroscopy.