Single-step EUS-guided pancreatic pseudocyst drainage using a large channel linear array echoendoscope and cystotome: results in 11 patients.

CONTEXT: EUS-guided transmural drainage of pancreatic pseudocyst has been reported using a linear array echoendoscope; however, placement of large 10 French stent was not feasible because of the limited diameter of the working channel. Recently linear array echoendoscopes with large working channel (3.7 to 3.8 mm) and newer accessories for pancreatic cyst puncture have become available; however, clinical data on their efficacy and safety in pancreatic pseudocyst drainage is not available. OBJECTIVE: To evaluate efficacy and safety of a one-step real time EUS-guided pancreatic pseudocyst drainage approach using a 3.8 mm channel linear array echoendoscope and cystotome. DESIGN: Prospective case series. SETTING: Tertiary care hospital endoscopy unit. PATIENTS AND INTERVENTIONS: A total of 12 EUS-guided pancreatic pseudocyst drainage procedures were performed in 11 patients with symptomatic pancreatic pseudocyst using a 3.8 mm channel linear array echoendoscope and cystotome. MAIN OUTCOME MEASUREMENTS: Complete resolution of pancreatic pseudocyst on imaging. RESULTS: Successful puncture of pancreatic pseudocyst and placement of 1 or 2 stents (10 Fr) was successful in all patients who were considered eligible for EUS-guided pancreatic pseudocyst drainage. Overall 9 patients out of a total of 11 (82%) were managed successfully with EUS-guided pseudocyst drainage. Two recurrences were noted over a mean follow-up period of 4 months (range 3-6 months). One patient underwent successful repeat drainage and the other patient was managed with surgical cystogastrostomy because of infected cyst contents. No major complication occurred. LIMITATIONS: Uncontrolled, small sample size. CONCLUSIONS: A single-step approach using a large channel (3.8 mm) linear array echoendoscope and cystotome appears feasible. This approach appears safe and effective in managing selected patients with symptomatic pancreatic pseudocysts.

Pancreatic tuberculosis diagnosed with endoscopic ultrasound guided fine needle aspiration.

CONTEXT: Isolated pancreatic tuberculosis is rare in the Western world. Its clinical presentation often mimics pancreatic malignancy and the diagnosis is usually not suspected or confirmed prior to laparotomy. Endoscopic ultrasound guided fine needle aspiration cytology has proved to be an excellent tool for the cytological diagnosis of pancreatic and peripancreatic masses. However, this technique has not been reported for diagnosing pancreatic or peripancreatic tuberculosis. CASE REPORT: We describe a 57-year-old South Asian man with pancreatic tuberculosis who presented with fever of undetermined origin and a pancreatic mass on imaging. He was successfully treated with anti-tuberculosis regimen following confirmation of his diagnosis with endoscopic ultrasound guided fine needle aspiration cytology. CONCLUSIONS: Pancreatic tuberculosis should be suspected in patients having a pancreatic mass, particularly if patient presents with fever and lived in, or traveled to, an area of endemic tuberculosis or exposed to tuberculosis. When the diagnosis is suspected, endoscopic ultrasound guided fine needle aspiration cytology of the pancreatic lesion can confirm the diagnosis and so avoid an unnecessary explorative laparotomy or pancreatic resection.

Primary mucosa-associated lymphoid tissue (MALT) lymphoma occurring in the rectum: a case report and review of the literature.

The primary extranodal B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) is a distinct clinical pathologic entity that develops in diverse anatomic locations such as the stomach, salivary gland, thyroid, lung, and breast; however, colorectal involvement is rare. To the best of our knowledge, only 30 cases of primary rectal MALT lymphoma have been published in the English language literature, mostly from Japan. A single case has been reported from the US before this report. The most common symptoms ranged from asymptomatic to occult or gross gastrointestinal bleeding. Simultaneous involvement of the cecum or colon was seen in 20% of the patients. Ninety percent of the patients were classified as low grade, Stage 1 at the time of diagnosis. Polypoid lesions were 10-fold more common than ulcerative lesions. Seven patients were reported to have H pylori in the stomach. The majority of the patients underwent surgical or endoscopic resection as a cure; however, controversy exists with regards to antibiotic treatment or observation alone because of unknown etiopathogenesis. Infection with microorganisms other than H pylori has been postulated in the development of rectal MALT lymphoma; however, this hypothesis remains unproven. The overall prognosis of rectal MALT lymphoma appears favorable; however, long-term follow-up data is lacking. Therefore, periodic clinical monitoring should be done in these patients.

Endoscopic treatment of duodenal perforation using a clipping device: case report and review of the literature.

The standard treatment for gastrointestinal perforation secondary to an endoscopic procedure is surgical repair. Some authors advocate a conservative medical management. However, this approach may be associated with increased morbidity and mortality. We describe a case of duodenal perforation secondary to snare polypectomy that was successfully treated with endoclipping. Additional published case reports were reviewed. Current data suggest that endoclipping may be appropriate in the management of a select group of patients with iatrogenic gastrointestinal perforation.