Endoscopic ultrasound and endoscopic ultrasound-guided fine needle aspiration in the diagnosis of diffuse gastrointestinal lesions with inconclusive endoscopic biopsies.

BACKGROUND/AIMS: Many gastrointestinal tumors appearing as diffuse circumferential malignancies, for example, diffuse signet ring adenocarcinoma and lymphoma, might primarily involve the submucosal layer and hence are difficult to diagnose because they frequently yield negative endoscopic biopsies. This main aim of this study was to evaluate the accuracy of endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) in the diagnosis of diffuse gastrointestinal lesions with inconclusive endoscopic biopsies. MATERIALS AND METHODS: This prospective study included 92 patients with diffuse or circumferential gastrointestinal lesions with non-conclusive biopsies that were taken during upper or lower endoscopy. EUS and EUS-FNA were performed on all patients with cytopathological examination. RESULTS: This study included 58 males (63%) and 34 females (37%) with a mean age of 54.2 years. Seventy-two cases (78.3%) were shown to have malignant lesions, and 20 cases (21.7%) were shown to be benign. EUS had a sensitivity of 94.4%, a specificity of 65%, a positive predictive value (PPV) of 90.7%, and a negative predictive value (NPV) of 45.1% with a p<0.0001 in diagnosing malignant lesions. EUS-FNA had a sensitivity of 83%, specificity of 100%, PPV of 100%, and NPV of 61.9% with a p<0.0001. CONCLUSION: Endoscopic ultrasound with EUS-FNA is an accurate procedure in the diagnosis of endoscopic biopsy-negative diffuse or circumferential gastrointestinal lesions.

Epidemiological and clinical characteristics of inflammatory bowel diseases in Cairo, Egypt.

AIM: To study the natural history, patterns and clinical characteristics of inflammatory bowel diseases (IBD) in Egypt. METHODS: We designed a case-series study in the gastroenterology centre of the Internal Medicine department of Cairo University, which is a tertiary care referral centre in Egypt. We included all patients in whom the diagnosis of ulcerative colitis (UC) or Crohn's disease (CD) was confirmed by clinical, laboratory, endoscopic, histological and/or radiological criteria over the 15 year period from 1995 to 2009, and we studied their sociodemographic and clinical characteristics. Endoscopic examinations were performed by 2 senior experts. This hospital centre serves patients from Cairo, as well as patients referred from all other parts of Egypt. Our centre received 24156 patients over the described time period for gastro-intestinal consultations and/or interventions. RESULTS: A total of 157 patients with established IBD were included in this study. Of these, 135 patients were diagnosed with UC (86% of the total), and 22 patients, with CD (14% of the total). The mean ages at diagnosis were 27.3 and 29.7, respectively. Strikingly, we noticed a marked increase in the frequency of both UC and CD diagnoses during the most recent 10 years of the 15 year period studied. Regarding the gender distribution, the male:female ratio was 1:1.15 for UC and 2.6:1 for CD. The mean duration of follow up for patients with UC was 6.2 ± 5.18 years, while the mean duration of follow up for patients with CD was 5.52 ± 2.83 years. For patients with UC we found no correlation between the severity of the disease and the presence of extraintestinal manifestations. Eleven patients had surgical interventions during the studied years: 4 cases of total colectomy and 7 cases of anal surgery. CONCLUSION: We observed a ratio of 6:1 for UC to CD in our series. The incidence of IBD seems to be rising in Egypt.