Endoscopic Supply Chain Management and Optimization.

Endoscopy is a procedural specialty that incurs significant cost through its high usage of consumables. Thus, supply chain management and optimization in endoscopy can improve value-based care, by identifying areas of cost saving in device procurement. Creating a multidisciplinary supply chain management team, such as multidisciplinary endoscopic device committee (MEDC), suggests a way to optimize supply chain. The essential components of MEDC are physicians, clinical administration, and institutional supply chain. The physicians in the committee identify new products, define the value of products, lead the product acquisition decision-making process, and generate a practice guideline to define meaningful use of the product. The tasks of MEDC are product acquisition aligning with clinical care, review of meaningful use, and utilization of guidelines creation. In conjunction with group purchasing organization (GPO), which aggregates purchasing volume to leverage cost saving during negotiations, MEDC offers a model to optimize the endoscopy supply chain management.

Fibrous Extracellular Spheroids in an Endoscopic Ultrasound-Guided Pancreatic Fine Needle Aspiration Correlating to a Gyriform Pancreatic Endocrine Tumor with a Unique Cobblestone Pavement Growth Pattern.

Pancreatic neuroendocrine neoplasms (PanNENs) are uncommon tumors. Fine needle aspiration (FNA) samples from PanNENs are typically of high cellularity and lack necrosis. In cytology slides from these tumors, dyscohesive cells are usually reported with variably round to oval to plasmacytoid forms exhibiting coarsely granular chromatin and showing immunoreactivity for synaptophysin. We present an unusual, and to our knowledge not previously described, example of an FNA of a PanNEN with large extracellular fibrous spheroids containing intrinsic fibroblasts and rimmed by small to intermediate sized neoplastic epithelial cells with high nuclear cytoplasmic ratios. The cytomorphology of the PanNEN in this case was in some ways reminiscent of that expected in adenoid cystic carcinomas of the salivary glands that most often contain large extracellular globules of basement membrane material and a somewhat biphasic population of lesional cells. The cytomorphology in this case was found to correlate well with the resection specimen histomorphology of an exaggerated gyriform pattern of growth resulting in a unique cobblestone-pavement like microscopic appearance. Knowledge of this potential cytomorphology will aid the cytology community through recognition and reporting of this previously undescribed pattern in an uncommon disease.

A minimally invasive treatment for early GI cancers.

Endoscopic submucosal dissection (ESD) allows curative resection of early malignant gastrointestinal (GI) lesions, potentially avoiding open surgery. Unfortunately, awareness of this technique is low, and many patients undergo surgery without consideration of ESD. This article reviews the indications for ESD and its advantages and limitations, and guides internists in their approach to patients with early GI cancer.