Assuntos
Colestase/cirurgia , Ducto Colédoco/cirurgia , Gastrectomia , Gastroenterostomia/métodos , Ducto Hepático Comum/cirurgia , Imãs , Técnicas de Sutura/instrumentação , Idoso , Anastomose Cirúrgica/instrumentação , Colangiopancreatografia por Ressonância Magnética , Colestase/complicações , Colestase/diagnóstico , Feminino , Humanos , Estenose Pilórica/complicações , Estenose Pilórica/cirurgia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND AND STUDY AIMS: Despite the development of peroral video cholangioscopy (PVCS), no prospective multicenter studies have been undertaken to investigate the diagnostic accuracy of PVCS in biliary tract diseases. Therefore, the aim of this study was to clarify the accuracy of PVCS in evaluating biliary tract lesions. PATIENTS AND METHODS: This study was a prospective multicenter study at five tertiary referral centers in Japan and included 87 eligible patients with biliary tract diseases who underwent PVCS. The study evaluated the ability of PVCS to diagnose indeterminate biliary tract diseases, detect mucosal cancerous extension preoperatively in extrahepatic bile duct cancers, and predict adverse events. RESULTS: The use of PVCS appearance alone correctly distinguished benign from malignant indeterminate biliary lesions in 92.1 % of patients whereas biopsy alone was accurate in 85.7 %. In extrahepatic bile duct cancer, mucosal cancer extended histologically at least 20 mm in 34.7 % (17/49) of patients. The accuracy rate of PVCS to evaluate the presence or absence of mucosal cancerous extension by endoscopic retrograde cholangiography (ERC) alone, ERC with PVCS, and ERC with PVCS + biopsy were 73.5 %, 83.7 %, and 92.9 %, respectively. Adverse events were seen in 6.9 % of PVCS patients, but no serious complications were observed. CONCLUSION: PVCS enhanced the accurate diagnosis of biliary tract lesions by providing excellent resolution in combination with biopsy.
Assuntos
Neoplasias dos Ductos Biliares/patologia , Ductos Biliares Extra-Hepáticos/patologia , Endoscopia do Sistema Digestório , Neoplasias da Vesícula Biliar/patologia , Neoplasias Hepáticas/patologia , Mucosa/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/complicações , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Extra-Hepáticos/cirurgia , Biópsia , Colangite/etiologia , Constrição Patológica/etiologia , Endoscopia do Sistema Digestório/efeitos adversos , Feminino , Neoplasias da Vesícula Biliar/complicações , Neoplasias da Vesícula Biliar/cirurgia , Hepatectomia , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Pancreaticoduodenectomia , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Adulto JovemAssuntos
Doenças Autoimunes/diagnóstico , Colangiopancreatografia Retrógrada Endoscópica , Colestase Extra-Hepática/diagnóstico , Doenças do Ducto Colédoco/diagnóstico , Granuloma de Células Plasmáticas/diagnóstico , Pancreatite/diagnóstico , Idoso , Doenças Autoimunes/patologia , Biópsia , Colestase Extra-Hepática/patologia , Ducto Colédoco/patologia , Doenças do Ducto Colédoco/patologia , Diagnóstico Diferencial , Granuloma de Células Plasmáticas/patologia , Humanos , Masculino , Pancreatite/patologiaAssuntos
Adesivos/uso terapêutico , Cianoacrilatos/uso terapêutico , Duodenopatias/cirurgia , Duodenoscopia , Fístula Intestinal/cirurgia , Fístula Pancreática/cirurgia , Idoso , Colangiopancreatografia Retrógrada Endoscópica , Duodenopatias/diagnóstico , Feminino , Humanos , Fístula Intestinal/diagnóstico , Fístula Pancreática/diagnósticoRESUMO
BACKGROUND AND STUDY AIMS: The aim of this prospective study was to compare endoscopic ultrasonography-guided Trucut needle biopsy (EUS-TNB) with EUS-guided fine-needle aspiration biopsy (EUS-FNAB) using 19- and 22-gauge needles for biopsy from different sites in patients with solid pancreatic cancers. PATIENTS AND METHODS: Sixteen consecutive patients with masses in the uncinate process (n = 3), the head (n = 5), or the body and tail (n = 8) of the pancreas underwent both EUS-TNB and EUS-FNAB. The specimens obtained were evaluated by histopathological analysis alone RESULTS: Tissue specimens were obtained by Trucut needle, and by 19-gauge and 22-gauge aspiration needles in 69 %, 69 %, and 100 % of patients respectively. Sensitivity for malignancy was 69 % for all needles. Tissue sampling by Trucut and by 19-gauge aspiration needle from masses in the uncinate process was impossible. The sensitivity of the Trucut and 19-gauge aspiration needles was 100 % in the 11 patients with successful procedures. If Trucut or 19-gauge aspiration needles had been used for body and tail masses, and the 22-gauge aspiration needle for masses in the uncinate process and head, the sensitivity for malignancy would have been 81 %. CONCLUSIONS: EUS-TNB allows reliable tissue sampling for the diagnosis of pancreatic masses, but its use is limited to lesions in the body and tail of the pancreas. EUS-FNAB using a 22-gauge needle may be useful for accurate diagnosis in some patients with masses in the uncinate process or the head of the pancreas.