RESUMEN
BACKGROUND AND AIMS: EUS-guided fine-needle core biopsy sampling is a safe and effective technique for diagnosis of focal liver lesions. However, data are limited in its role in parenchymal disease. We evaluated the utility of EUS-guided parenchymal liver biopsy sampling with a modified 1-pass wet suction technique (EUS-modified liver biopsy sampling [EUS-MLB]) in patients with unexplained increase in liver-associated tests. METHODS: We retrospectively evaluated the safety and efficacy of EUS-MLB in patients referred for EUS to evaluate for biliary obstruction and pancreatic disorders but with associated unexplained liver tests. EUS-MLB was performed during the same session after biliary obstruction was excluded. RESULTS: One hundred sixty-five consecutive patients underwent EUS-MLB. The median age was 52 years (interquartile range [IQR], 42-65). Sixty-eight patients (41%) were men. The median of the maximum intact core tissue length was 2.4 cm (IQR, 1.8-3.5). The median total specimen length (TSL) was 6 cm (IQR, 4.3-8). The median number of complete portal tracts (CPTs) per TSL was 18 (IQR, 13- 24). The mean number of CPTs per sample length was 7.5 cm. Adverse events were uncommon (1.8%) and included abdominal pain and self-limited hematoma. CONCLUSIONS: EUS-guided fine-needle biopsy sampling using a novel 19-gauge core needle with a modified 1-pass 1 actuation wet suction technique (EUS-MLB) is a safe and effective way to evaluate patients with unexplained liver tests abnormalities who are undergoing EUS for exclusion of biliary obstruction.
Asunto(s)
Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/métodos , Hepatopatías/patología , Hígado/patología , Tejido Parenquimatoso/patología , Dolor Abdominal/etiología , Adulto , Anciano , Colestasis/etiología , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/efectos adversos , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/instrumentación , Femenino , Hematoma/etiología , Humanos , Hígado/diagnóstico por imagen , Hepatopatías/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Agujas , Tejido Parenquimatoso/diagnóstico por imagen , Estudios Retrospectivos , SucciónAsunto(s)
Biopsia/métodos , Endosonografía/métodos , Hígado Graso/complicaciones , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/patología , Biopsia/efectos adversos , Endosonografía/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
Accessory spleens and splenosis represent the congenital and acquired type of ectopic splenic tissue. Generally, they are asymptomatic entities posing as solid hypervascular masses at the splenic hilum or in other organs, such as the pancreas. Intrapancreatic ectopic spleen mimics pancreatic neoplasms on imaging studies, and due to the lack of radiological diagnostic criteria, patients undergo unnecessary distal pancreatectomy. We present the first case of intrapancreatic ectopic spleen in which the concomitant use of needle-based probe confocal laser endomicroscopy and fine-needle aspiration supported the final diagnosis.
RESUMEN
This article reviews different techniques available for diagnosis and staging of patients with non-small cell lung cancer (NSCLC). The advantages and disadvantages of each staging method are highlighted. The role of the gastroenterologist in NSCLC staging is explored. A new algorithm is proposed for the staging of NSCLC that incorporates endoscopic and endobronchial ultrasonography for mediastinal staging in patients with intrathoracic disease.