Asunto(s)
Neoplasias de los Conductos Biliares/patología , Biopsia/métodos , Colangiocarcinoma/patología , Colangiopancreatografia Retrógrada Endoscópica/métodos , Neoplasias Pancreáticas/patología , Neoplasias de los Conductos Biliares/diagnóstico , Colangiocarcinoma/diagnóstico , Humanos , Hibridación Fluorescente in Situ , Microscopía Confocal , Neoplasias Pancreáticas/diagnóstico , Sensibilidad y EspecificidadAsunto(s)
Ampolla Hepatopancreática/cirugía , Enfermedades del Conducto Colédoco/cirugía , Hemorragia Gastrointestinal/etiología , Granuloma Piogénico/cirugía , Anciano , Ampolla Hepatopancreática/diagnóstico por imagen , Ampolla Hepatopancreática/patología , Enfermedad Crónica , Enfermedades del Conducto Colédoco/complicaciones , Enfermedades del Conducto Colédoco/diagnóstico por imagen , Enfermedades del Conducto Colédoco/patología , Endoscopía del Sistema Digestivo , Endosonografía , Femenino , Granuloma Piogénico/complicaciones , Granuloma Piogénico/diagnóstico por imagen , Granuloma Piogénico/patología , HumanosRESUMEN
Background and study aims The Full-Thickness Resection Device (FTRD) provides a novel treatment option for lesions not amenable to conventional endoscopic resection techniques. There are limited data on the efficacy and safety of FTRD for resection of upper gastrointestinal tract (GIT) lesions. Patients and methods This was an international multicenter retrospective study, including patients who had an endoscopic resection of an upper GIT lesion using the FTRD between January 2017 and February 2019. Results Fifty-six patients from 13 centers were included. The most common lesions were mesenchymal neoplasms (nâ=â23, 41â%), adenomas (nâ=â7, 13â%), and hamartomas (nâ=â6, 11â%). Eighty-four percent of lesions were located in the stomach, and 14â% in the duodenum. The average size of lesions was 14âmm (range 3 to 33âmm). Deployment of the FTRD was technically successful in 93â% of patients (nâ=â52) leading to complete and partial resection in 43 (77â%) and 9 (16â%) patients, respectively. Overall, the FTRD led to negative histological margins (R0 resection) in 38 (68â%) of patients. A total of 12 (21â%) mild or moderate adverse events (AEs) were reported. Follow-up endoscopy was performed in 31 patients (55â%), on average 88 days after the procedure (IQR 68-138 days). Of these, 30 patients (97â%) did not have any residual or recurrent lesion on endoscopic examination and biopsy, with residual adenoma in one patient (3â%). Conclusions Our results suggest a high technical success rate and an acceptable histologically complete resection rate, with a low risk of AEs and early recurrence for FTRD resection of upper GIT lesions.
RESUMEN
OBJECTIVES: Distinguishing neuroendocrine tumors (NETs) and other pancreas lesions from adenocarcinomas via endoscopic ultrasound (EUS) requires additional tissue for special staining and processing. Our aim was to determine if main pancreatic duct (PD) diameter on EUS helps to differentiate NET and other unusual tumors from adenocarcinoma. METHODS: We evaluated 30 consecutive patients diagnosed with NET or other pancreas lesions by EUS with 90 matched patients who were found to have adenocarcinoma. Dilated PD was defined as greater than 3 mm. Multivariate logistic regression was used to evaluate associations between lesion type and PD diameter. RESULTS: Among the 30 patients with NET/other pancreas lesions, 21 had NETs, 7 had metastases, and 2 had lymphomas. A dilated PD was demonstrated in only 3.3% of pancreatic NET/other lesions but present in 88.9% of cases of primary adenocarcinoma (P < 0.01). In multivariate analysis, a normal PD diameter and absence of clinical symptoms strongly predicted the presence of pancreatic NET/other versus adenocarcinoma (P < 0.01). CONCLUSIONS: The absence of PD dilation upstream of the lesion suggests NET or other lesions rather than adenocarcinoma. This finding should prompt endosonographers to obtain additional tissue at the time of EUS to send for special studies.
Asunto(s)
Adenocarcinoma/diagnóstico por imagen , Endosonografía/métodos , Tumores Neuroendocrinos/diagnóstico por imagen , Páncreas/diagnóstico por imagen , Conductos Pancreáticos/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico por imagen , Adenocarcinoma/diagnóstico , Diagnóstico Diferencial , Humanos , Modelos Logísticos , Análisis Multivariante , Tumores Neuroendocrinos/diagnóstico , Páncreas/patología , Conductos Pancreáticos/anatomía & histología , Neoplasias Pancreáticas/diagnóstico , Estudios ProspectivosRESUMEN
OBJECTIVES: The aims of this study were to evaluate whether serum pancreatic enzyme levels could be used to aid screening for chronic pancreatitis (CP). METHODS: 170 healthy volunteers were screened and prospectively enrolled in the control group. 150 patients who were diagnosed with calcific CP were enrolled in the patient group by retrospective review. Serum amylase and lipase levels were compared between the 2 groups. RESULTS: The mean values ± SD of the control group were compared with those of the patient group for serum amylase level (48.1 ± 13.2 vs 34.8 ± 17.2 U/L, P < 0.001) and serum lipase level (26.4 ± 11.3 vs 16.3 ± 11.2 U/L, P < 0.001). On the receiver operating characteristic curve analysis for amylase level, area under the curve was 0.740 (95% confidence interval), and sensitivity and specificity were 38.7% and 94.1%, respectively, with a cutoff value of 27.5 U/L. On the receiver operating characteristic curve analysis for lipase level, area under the curve was 0.748 (95% confidence interval), and sensitivity and specificity were 33.3% and 95.9%, respectively, with a cutoff value of 10.5 U/L. CONCLUSIONS: Our results suggest that low serum pancreatic enzyme levels can be used to aid in detection of CP.