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1.
Endosc Int Open ; 12(10): E1118-E1126, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39398445

RESUMO

Background and study aims Artificial intelligence (AI) models have demonstrated high diagnostic performance identifying neoplasia during digital single-operator cholangioscopy (DSOC). To date, there are no studies directly comparing AI vs. DSOC-guided probe-base confocal laser endomicroscopy (DSOC-pCLE). Thus, we aimed to compare the diagnostic accuracy of a DSOC-based AI model with DSOC-pCLE for identifying neoplasia in patients with indeterminate biliary strictures. Patients and methods This retrospective cohort-based diagnostic accuracy study included patients ≥ 18 years old who underwent DSOC and DSOC-pCLE (June 2014 to May 2022). Four methods were used to diagnose each patient's biliary structure, including DSOC direct visualization, DSOC-pCLE, an offline DSOC-based AI model analysis performed in DSOC recordings, and DSOC/pCLE-guided biopsies. The reference standard for neoplasia was a diagnosis based on further clinical evolution, imaging, or surgical specimen findings during a 12-month follow-up period. Results A total of 90 patients were included in the study. Eighty-six of 90 (95.5%) had neoplastic lesions including cholangiocarcinoma (98.8%) and tubulopapillary adenoma (1.2%). Four cases were inflammatory including two cases with chronic inflammation and two cases of primary sclerosing cholangitis. Compared with DSOC-AI, which obtained an area under the receiver operator curve (AUC) of 0.79, DSOC direct visualization had an AUC of 0.74 ( P = 0.763), DSOC-pCLE had an AUC of 0.72 ( P = 0.634), and DSOC- and pCLE-guided biopsy had an AUC of 0.83 ( P = 0.809). Conclusions The DSOC-AI model demonstrated an offline diagnostic performance similar to that of DSOC-pCLE, DSOC alone, and DSOC/pCLE-guided biopsies. Larger multicenter, prospective, head-to-head trials with a proportional sample among neoplastic and nonneoplastic cases are advisable to confirm the obtained results.

2.
Dig Dis Sci ; 69(8): 3015-3018, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38713274

RESUMO

BACKGROUND: Viral infections are known to impact the pancreato-biliary system; however, there are limited data showing that the same is true of COVID-19. Endoscopic retrograde cholangiopancreatography (ERCP) can safely be performed in patients with COVID-19 infection, but outcomes of patients with COVID-19 infections and concomitant pancreatic and biliary disease requiring endoscopic intervention are unknown. AIMS: This study aims to evaluate the severity of pancreaticobiliary diseases and post-ERCP outcomes in COVID-19 patients. METHODS: Patients with pancreato-biliary disease that required inpatient ERCP from five centers in the United States and South America between January 1, 2020, and October 31, 2020 were included. A representative cohort of patients from each month were randomly selected from each site. Disease severity and post-ERCP outcomes were compared between COVID-19 positive and COVID-19 negative patients. RESULTS: A total of 175 patients were included: 95 COVID positive and 80 COVID negative. Mean CTSI score for the patients who had pancreatitis was higher in COVID-positive cohort by 3.2 points (p < .00001). The COVID-positive group had more cases with severe disease (n = 41) versus the COVID-negative group (n = 2) (p < .00001). Mortality was higher in the COVID-19 positive group (19%) compared to COVID-negative group (7.5%) even though the COVID-19-negative group had higher incidence of malignancy (n = 17, 21% vs n = 7, 7.3%) (p = 0.0455). CONCLUSIONS: This study shows that patients with COVID infection have more severe pancreato-biliary disease and worse post-ERCP outcomes, including longer length of stay and higher mortality rate. These are important considerations when planning for endoscopic intervention. CLINICALTRIALS: gov: (NCT05051358).


Assuntos
Doenças Biliares , COVID-19 , Colangiopancreatografia Retrógrada Endoscópica , Pancreatopatias , Humanos , COVID-19/complicações , COVID-19/mortalidade , COVID-19/terapia , COVID-19/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Doenças Biliares/epidemiologia , Estados Unidos/epidemiologia , Índice de Gravidade de Doença , Estudos Retrospectivos , SARS-CoV-2 , Tempo de Internação/estatística & dados numéricos
3.
Endosc Int Open ; 12(4): E498-E506, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38585021

RESUMO

Background and study aims Digital single-operator cholangioscopy (DSOC) allows the diagnosis of biliary duct disorders and treatment for complicated stones. However, these technologies have limitations such as the size of the probe and working channel, excessive cost, and low image resolution. Recently, a novel DSOC system (eyeMAX, Micro-Tech, Nanjing, China) was developed to address these limitations. We aimed to evaluate the usefulness and safety of a novel 9F and 11F DSOC system in terms of neoplastic diagnostic accuracy based on visual examination, ability to evaluate tumor extension and to achieve complete biliary stone clearance, and procedure-related adverse events (AEs). Patients and methods Data from ≥ 18-year-old patients who underwent DSOC from July 2021 to April 2022 were retrospectively recovered and divided into a diagnostic and a therapeutic cohort. Results A total of 80 patients were included. In the diagnostic cohort (n = 49/80), neovascularity was identified in 26 of 49 patients (46.9%). Biopsy was performed in 65.3% patients with adequate tissue sample obtained in 96.8% of cases. Biopsy confirmed neoplasia in 23 of 32 cases. DSOC visual impression achieved 91.6% sensitivity and 87.5% specificity in diagnosing neoplasms. In the therapeutic cohort (n = 43/80), 26 of 43 patients required lithotripsy alone. Total stone removal was achieved in 71% patients in the first session. Neither early nor late AEs were documented in either the diagnostic or therapeutic cohort. Conclusions The novel DSOC device has excellent diagnostic accuracy in distinguishing neoplastic biliary lesions as well as therapeutic benefits in the context of total stone removal, with no documented AEs.

4.
Gastrointest Endosc ; 100(2): 250-258, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38518978

RESUMO

BACKGROUND AND AIMS: EUS-guided radiofrequency ablation (EUS-RFA) has emerged as an alternative for the local treatment of unresectable pancreatic ductal adenocarcinoma (PDAC). We assessed the feasibility and safety of EUS-RFA in patients with unresectable PDAC. METHODS: This study followed an historic cohort compounded by locally advanced (LA-) and metastatic (m)PDAC-naïve patients who underwent EUS-RFA between October 2019 and March 2022. EUS-RFA was performed with a 19-gauge needle electrode with a 10-mm active tip for energy delivery. Study primary endpoints were feasibility, safety, and clinical follow-up, whereas secondary endpoints were performance status (PS), local control, and overall survival (OS). RESULTS: Twenty-six patients were selected: 15 with locally advanced pancreatic duct adenocarcinoma (LA-PDAC) and 11 with metastatic pancreatic duct adenocarcinoma (mPDAC). Technical success was achieved in all patients with no major adverse events. Six months after EUS-RFA, OS was seen in 11 of 26 patients (42.3%), with significant PS improvement (P = .03). Local control was achieved, with tumor reduction from 39.5 mm to 26 mm (P = .04). A post-treatment hypodense necrotic area was observed at the 6-month follow-up in 11 of 11 patients who were still alive. Metastatic disease was a significant factor for worsening OS (hazard ratio, 5.021; 95% confidence interval, 1.589-15.87; P = .004). CONCLUSIONS: EUS-RFA for the treatment of pancreatic adenocarcinoma is a minimally invasive and safe technique that may have an important role as targeted therapy for local treatment of unresectable cases and as an alternative for poor surgical candidates. Also, RFA may play a role in downstaging cancer with a potential increase in OS in nonmetastatic cases. Large prospective cohorts are required to evaluate this technique in clinical practice.


Assuntos
Carcinoma Ductal Pancreático , Endossonografia , Neoplasias Pancreáticas , Ablação por Radiofrequência , Humanos , Neoplasias Pancreáticas/cirurgia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/diagnóstico por imagem , Masculino , Feminino , Carcinoma Ductal Pancreático/cirurgia , Carcinoma Ductal Pancreático/patologia , Carcinoma Ductal Pancreático/diagnóstico por imagem , Idoso , Endossonografia/métodos , Pessoa de Meia-Idade , Ablação por Radiofrequência/métodos , Estudos de Coortes , Estudos de Viabilidade , Idoso de 80 Anos ou mais , Ultrassonografia de Intervenção , Estudos Retrospectivos , Resultado do Tratamento
6.
Endoscopy ; 55(8): 719-727, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-36781156

RESUMO

BACKGROUND: We aimed to develop a convolutional neural network (CNN) model for detecting neoplastic lesions during real-time digital single-operator cholangioscopy (DSOC) and to clinically validate the model through comparisons with DSOC expert and nonexpert endoscopists. METHODS: In this two-stage study, we first developed and validated CNN1. Then, we performed a multicenter diagnostic trial to compare four DSOC experts and nonexperts against an improved model (CNN2). Lesions were classified into neoplastic and non-neoplastic in accordance with Carlos Robles-Medranda (CRM) and Mendoza disaggregated criteria. The final diagnosis of neoplasia was based on histopathology and 12-month follow-up outcomes. RESULTS: In stage I, CNN2 achieved a mean average precision of 0.88, an intersection over the union value of 83.24 %, and a total loss of 0.0975. For clinical validation, a total of 170 videos from newly included patients were analyzed with the CNN2. Half of cases (50 %) had neoplastic lesions. This model achieved significant accuracy values for neoplastic diagnosis, with a 90.5 % sensitivity, 68.2 % specificity, and 74.0 % and 87.8 % positive and negative predictive values, respectively. The CNN2 model outperformed nonexpert #2 (area under the receiver operating characteristic curve [AUC]-CRM 0.657 vs. AUC-CNN2 0.794, P < 0.05; AUC-Mendoza 0.582 vs. AUC-CNN2 0.794, P < 0.05), nonexpert #4 (AUC-CRM 0.683 vs. AUC-CNN2 0.791, P < 0.05), and expert #4 (AUC-CRM 0.755 vs. AUC-CNN2 0.848, P < 0.05; AUC-Mendoza 0.753 vs. AUC-CNN2 0.848, P < 0.05). CONCLUSIONS: The proposed CNN model distinguished neoplastic bile duct lesions with good accuracy and outperformed two nonexpert and one expert endoscopist.


Assuntos
Inteligência Artificial , Neoplasias , Humanos , Redes Neurais de Computação , Curva ROC , Valor Preditivo dos Testes
7.
Gastrointest Endosc ; 97(3): 445-453, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36328209

RESUMO

BACKGROUND AND AIMS: Patients with distal malignant biliary obstruction (MBO) and cystic duct orifice tumoral involvement have an increased risk for the development of acute cholecystitis after self-expandable metallic stent (SEMS) placement. We aimed to determine whether primary EUS-guided gallbladder drainage prevents acute cholecystitis in these patients. METHODS: This was a single-center, randomized control trial in patients with distal MBO enrolled from July 2018 to July 2020. Patients were randomized into 2 groups: an interventional group treated with conventional ERCP biliary drainage with SEMS placement and subsequent primary EUS-guided gallbladder drainage (EUS-GBD) and a control group treated with conventional biliary drainage alone. The primary outcome of the study was the occurrence of post-treatment acute cholecystitis, assessed for ≤12 months or until death. The secondary outcomes were hospitalization length and median survival time. RESULTS: Forty-four patients were included in the study: 22 in each group. Five patients in the control group (22.7%) and none in the intervention group experienced acute cholecystitis. The median hospitalization time was significantly lower in the interventional group than in the control group (2 days vs 1 day, P = .017). There was no difference in the observed median survival rates in the primary EUS-GBD group (2.9 months) and the control group (2.8 months) (P = .580). CONCLUSION: In this single-center study of patients with unresectable MBO and occlusion of the cystic duct orifice, prophylactic EUS-GBD demonstrated a reduced incidence of acute cholecystitis.


Assuntos
Colecistite Aguda , Colestase , Neoplasias , Humanos , Vesícula Biliar/diagnóstico por imagem , Ducto Cístico , Endossonografia/efeitos adversos , Colecistite Aguda/complicações , Colecistite Aguda/cirurgia , Neoplasias/complicações , Drenagem/efeitos adversos , Colestase/etiologia , Colestase/prevenção & controle , Colestase/cirurgia , Stents/efeitos adversos
8.
Artigo em Inglês | MEDLINE | ID: mdl-35548472

RESUMO

An early and accurate diagnosis of biliary strictures yields optimal patient outcomes; however, endoscopic retrograde cholangiopancreatography (ERCP) with cytobrush/biopsy forceps has low sensitivity with a high number of false negatives. Various attempts to improve the accuracy of diagnosing indeterminate biliary strictures though ERCP-guided specimen acquisition have been proposed, such as with the use of fluorescence in situ hybridization, an endoscopic scraper, and the wire-grasping method, with modest to large improvements in sensitivity. Direct visualization of the biliary tree during peroral cholangioscopy has shown high sensitivity and specificity for the differentiation of neoplastic and non-neoplastic biliary lesions; however, there is no consensus on the visual characteristics of neoplastic lesions and moderate agreement between observers. Peroral cholangioscopy system (POCS)-guided specimen acquisition using forceps has shown inferior sensitivity compared to the visual characteristics; however, the specificity remains high. Optimal specimen processing with onsite evaluations and touch imprint cytology have been shown to improve the sensitivity and accurately diagnose nearly 90% of patients. In vivo evaluations of biliary strictures with probe-based confocal laser endomicroscopy have demonstrated high sensitivity with modest specificity for malignant biliary strictures. Optical computed tomography described reproductible criteria for malignancy detection in biliary strictures, increasing the sensitivity during ERCP evaluations. Differentiating benign causes from malignant causes of biliary strictures is a challenging task in clinical practice, with various concerns that still need to be addressed. Efforts should be made to define each diagnostic method's role in the evaluation of indeterminate biliary strictures.

10.
VideoGIE ; 7(2): 74-76, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35146230

RESUMO

Video 1EUS-guided microwave ablation of an unresectable pancreatic mass using a novel generator platform and a specialized 19.5-gauge needle antenna.

11.
Gastrointest Endosc ; 93(4): 935-941, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32707155

RESUMO

BACKGROUND AND AIMS: Various macroscopic features are proposed for the diagnosis of biliary lesions during digital single-operator cholangioscopy (DSOC); however, neovasculature may be one of the most reliable features of neoplasia. We aimed to evaluate the detection of neovasculature during DSOC to distinguish neoplastic from non-neoplastic bile duct lesions. METHODS: A retrospective, single-center, cohort study was used. Neovasculature was defined as the presence of irregular or "spider" vascularity on bile duct lesions. The accuracy of detection of neovasculature for the identification of neoplastic lesions was estimated using the histologic results, surgical specimens, and/or 6-month follow-up as the criterion standard. Interobserver agreement analysis (kappa value) was performed between 2 expert endoscopists and 3 nonexpert physicians. RESULTS: Ninety-five patients were included; the median age was 65.6 years (range, 20-93 years), and 51 (53.7%) patients were female. Signs of neovasculature were observed in 65 of 95 (68.4%) patients. Histology confirmed neoplasia in 48 of 95 (50.5%) patients, and 6-month follow-up survival confirmed neoplasia in 52 of 95 (54.7%) patients. The use of vascularity for identifying neoplastic lesions achieved an accuracy of 80%, sensitivity of 94%, specificity of 63%, positive predictive value of 75%, negative predictive value of 90%, positive likelihood ratio of 2.53 (95% confidence interval, 1.71-3.76), and negative likelihood ratio of 0.09 (95% confidence interval, 0.03-0.28). The interobserver and intraobserver agreement were excellent (κ > 80%; P < .001) between expert endoscopists and nonexpert physicians. CONCLUSION: Detection of irregular or spider vascularity on bile duct lesions during DSOC evaluations accurately identifies biliary neoplastic lesions. Prospective multicenter trials are required to evaluate neovasculature as a single factor for predicting neoplasia.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar , Idoso , Ductos Biliares , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Sensibilidade e Especificidade
12.
Rev Esp Enferm Dig ; 112(6): 501-502, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32379475

RESUMO

The case was an 82-year-old Hispanic female who complained of painless jaundice and weight loss. Endoscopic retrograde cholangiopancreatography (ERCP) showed a distal common bile duct (CBD) stricture with dilatation of the intra and extra-hepatic bile ducts.


Assuntos
Ductos Biliares Extra-Hepáticos , Carcinoma Neuroendócrino , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica , Ducto Colédoco , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/etiologia , Feminino , Humanos
13.
Rev Esp Enferm Dig ; 111(12): 977, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31793326

RESUMO

We read with great interest the scientific letter by Sánchez Melgarejo JF et al., in which they report a degenerate Todani Ia choledochal cyst in a patient with a pancreas divisum. However, patients with a choledochal cyst might benefit from per oral cholangioscopy for malignancy detection and extension evaluation.


Assuntos
Cisto do Colédoco/cirurgia , Laparoscopia , Humanos , Pâncreas
15.
Medicina (Guayaquil) ; 16(4): 250-256, 2011.
Artigo em Espanhol | LILACS | ID: lil-652665

RESUMO

Antecedentes: la identificación temprana del deterioro de la función renal es crucial en los pacientes diabéticos. Clínicamente la cistatina C sérica podría ser el indicador más sensible de tasa de filtrado glomerular. Objetivo: proponer el uso de cistatina C como prueba de rutina para evaluar la función renal en pacientes diabéticos tipo 2. Metodología: se realizó un estudio observacionalde corte transversal en 115 pacientes diabéticos tipo 2 normo albuminúricos, estableciendo la tasa de filtrado glomerular con valores de cistatina C y fórmula de Cockroft–Gault. A aquellos con un filtrado glomerular < 60 ml/min se realizó depuración de creatinina en orina de 24 horas; y se comparó los resultados con el programa estadístico SPSS 17, presentando los datos entablas de contingencia con análisis de riesgo y test de significancia de X2. Resultados: la tasa de filtrado glomerular obtenida con cistatina C, tuvo un valor promedio de 99ml/min±19.07, mientras que la de Cockroft-Gault un valor de 79.85ml/min±23.63 reflejando mejor correlación con aclaramiento de creatinina en orina de 24 horas que obtuvo un valor de 74.95ml/min±37.41.Al relacionar los valores con la depuración de creatinina en orina de 24 horas, no hubo una relación significativa entre ambos parámetros (p=0.14). Conclusión: la tasa de filtrado glomerular con cistatina C presenta una gran dispersión en la correlación conla depuración de creatinina en orina de 24 horas; este hecho, junto a diversos factores que influyen en su variabilidad, y el mayor coste de su determinación, hacen poco justificable su uso para valorar función renal.


Background: early identification of renal function impairment is crucial in diabetic patients. Clinically, serum cystatin C may be the most sensitive indicator of the glomerular filtration rate. Objective: to propose the use of cystatin C as a routine test to evaluate kidney function in type 2 diabetic patients. Methodology: an observational cross sectional study was done with 115 normoalbuminurictype 2 diabetic patients, establishing the glomerular filtration rate using cystatin C values and the Cockcroft-Gault formula. For those with a glomerular filtration rate <60 ml/min, a 24-hour creatinine clearance in urine test was performed, and the results were compared using SPSS 17, presenting the data in contingency tables with risk analysis and significance tests of X2. Results: the glomerular filtration rate obtained with cystatin C had a mean value of 99ml/min±19.07, while that obtained with the Cockroft-Gault formula was 79.85ml/min±23.63, which showed better correlation with the 24-hour creatinine clearance test with a value of 74.95ml/min±37.41. Neither parameter showed a significant relationship with the 24-hour creatinine clearance test values (p = 0.14). Conclusion: the glomerular filtration rate obtained using cystatin C has a large dispersion when correlated with the 24-hour creatinine clearance in urine test values. This fact, together with the different factors influencing its variability and the higher cost of its determination; result in little justification for its use in assessing renal function


Assuntos
Masculino , Adulto , Feminino , Adulto Jovem , Cistatina C/diagnóstico , Diabetes Mellitus , Falência Renal Crônica , Albuminúria , Creatinina , Taxa de Filtração Glomerular
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