Use of positron emission tomography in surgery follow-up of esophageal cancer.

INTRODUCTION: Although the prognosis of patients with esophageal cancer has been improved by extended dissection, the incidence of recurrence still remains high. In esophageal cancer, positron emission tomography (PET) using (18)F-fluorodeoxyglucose (FDG) already demonstrated to be useful for initial staging and monitoring response to therapy. This prospective study compared the ability of FDG-PET and conventional imaging to detect early recurrence of esophageal cancer after initial surgery in asymptomatic patients. MATERIALS AND METHODS: Between October 2003 and September 2006, 41 patients with esophageal cancer were included in a prospective study after initial radical esophagectomy. FDG-PET, thoracoabdominal computed tomography (CT), abdominal ultrasonography, and endoscopy were performed every 6 months after initial treatment. RESULTS AND DISCUSSION: Twenty-three patients had recurrent disease (56%), mostly within the first 6 months after surgery (70%). Despite two false-positive scans due to postoperative changes, FDG-PET was more accurate than CT (91% vs. 81%, p = 0.02) for the detection of recurrence with a sensitivity of 100% (vs. 65%), a specificity of 85% (vs. 91%), and a negative predictive value of 100% on a patient-by-patient-based analysis. For the detection of locoregional recurrence, FDG-PET was more accurate than CT (96.2% vs. 88.9%). FDG-PET was also more accurate than CT for the detection of distant metastases (92.5% vs. 84.9%), especially when involving either bones (100%) or liver (98.1%). A lower sensitivity of FDG-PET (57%) for the early detection of small lung metastases did not affect patient management (accuracy = 92.5%). CONCLUSION: FDG-PET appears to be very useful for the systematic follow-up of asymptomatic patients after esophagectomy with an initial scan performed 6 months after surgery.

Endoscopic treatment of painful chronic pancreatitis: evaluation of a new flexible multiperforated plastic stent.

OBJECTIVES: Endoscopic stents are a validated treatment for painful chronic calcifying pancreatitis (CCP). Biliary-type stents are the most commonly used, but have certain drawbacks. The aim of this single-center retrospective study was to evaluate the feasibility, and the short- and medium-term efficacy of a new pancreatic stent (Johlin model, Cook) for pain relief. METHODS: Thirteen patients with painful CCP were treated with a Johlin stent. Stent specifications were studied as well as feasibility and efficacy. Success was defined as relief of pain. RESULTS: There was no placement failure with the initial stent, which was 13.4+/-2.1cm in length and 9.8+/-0.6 Fr in diameter. Immediate total pain relief following stenting occurred in 11 patients. The average follow-up time was 11+/-7 months (range 1.5-24 months). Stents were left in place for 4.5+/-3 months (range 0.5-13.5 months). At the end of follow-up, endoscopic treatment was considered effective in 12 patients. Endoscopic retrograde cholangiopancreatographic (ERCP) complications consisted of uncomplicated acute pancreatitis (10%). CONCLUSION: Pancreatic stenting using the Johlin stent (Cook) is feasible, has no particular adverse events and is effective for immediate as well as medium-term pain improvement.