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Dyspepsia is a common group of clinical symptoms and can be classified into organic and functional dyspepsia. Patients with chronic pancreatitis （CP） often have the symptoms of dyspepsia such as fatty diarrhea， abdominal distention， and abdominal pain， and most patients have pancreatic exocrine insufficiency （PEI）， which belongs to organic dyspepsia. In clinical practice， the diagnosis of PEI and dyspepsia requires a comprehensive assessment of clinical manifestations， nutritional status， and pancreatic exocrine function， and an individualized treatment regimen should be developed based on such factors. However， some patients with normal exocrine function may have the symptoms of dyspepsia， and the diagnosis and treatment of such patients are still difficulties in clinical practice. This article reviews the advances in the diagnosis and treatment of dyspepsia in CP patients.
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Objective:To evaluate the value of endoclip-assisted and submucosal injection-assisted cannulation techniques for difficult cannulation during endoscopic retrograde cholangiopancreatography (ERCP).Methods:Data of 12 458 patients treated with ERCP for the first time in the First Affilated Hospital of Naval Medical University from June 2015 to September 2020 were retrospectively analyzed. Twenty eight (0.22%) were identified as difficult cannulation where metal clip- or submucosal injection-assisted cannulation was used. The selective cannulation success rate, intubation time and complication incidence of the two techniques in difficult cannulation patients were analyzed.Results:Difficult cannulation was performed in 18 males (64.3%) and 10 females (35.7%) with an age of 69.6±14.1 years assisted by metal clips or submucosal injection. Five cases (17.9%) were type Ⅱ, 5 cases (17.9%) type Ⅲ, and 18 cases (64.3%) type Ⅴ according to papilla classification. Sixteen patients (57.1%) received metal clip-assisted cannulation, and 12 cases (42.9%) submucosal injection-assisted cannulation. Twenty-five (89.3%) patients successfully underwent selective cannulation with the cannulation time of 9.9±4.3 min. One case (3.6%) of mild post-ERCP pancreatitis and 3 cases (10.7%) of post-ERCP hyperamylasemia occurred. No postoperative bleeding or perforation occurred. All patients were cured and discharged after conservative treatment.Conclusion:When selective cannulation is difficult due to poor papilla exposure or deflection, endoclip- or submucosal injection-assisted cannulation can effectively improve the successful selective cannulation rate during ERCP with low complication incidence, which is worth of clinical promotion.
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Objective:To analyze the characteristics of pancreatic metastatic tumors and evaluate the clinical value of endoscopic ultrasound-guided fine-needle aspiration or biopsy (EUS-FNA/B) in their diagnosis.Methods:A retrospective analysis was conducted on clinical, radiological, and pathological data of 11 cases with pancreatic metastatic tumors diagnosed by EUS-FNA/B at the First Affiliated Hospital of Naval Medical University between January 2011 and December 2020. Tumor size, number of lesions, time interval between diagnosis of metastatic lesions and primary tumors, radiological and EUS findings and pathological types were recorded, and success rate and diagnostic rate of EUS-FNA/B were analyzed.Results:The 11 patients with pancreatic metastatic tumors had an age range of 43 to 76 years, including 7 males and 4 females. Eight cases presented with symptoms of abdominal pain and poor appetite, 1 case had cervical lymph node enlargement, and 2 cases were detected during routine physical examination. Five cases had abnormal serum tumor markers. All patients had a confirmed history of primary tumors, and the median time interval between diagnosis of pancreatic metastatic lesions and primary tumors was 24 months (-1-124 months). Seven cases had solitary lesions, and 4 cases had multiple nodules under EUS. Eight cases were initially diagnosed clinically as pancreatic lesions or tumor, while 3 cases were considered as pancreatic metastatic tumor. All of 11 cases underwent EUS-FNA/B and were histologically confirmed as pancreatic metastatic tumors. The most common pathological type was lung small cell neuroendocrine cancer ( n=4), followed by renal cell carcinoma ( n=3), and esophageal squamous cell carcinoma ( n=1), pulmonary squamous cell carcinoma( n=1), malignant melanoma ( n=1), and gastric adenocarcinoma ( n=1). Conclusions:The pancreas is not a common target site for tumor metastasis.EUS-FNA/B is a relatively safe minimally invasive method for the diagnosis of pancreatic metastatic tumors.
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Endoscopic ultrasound⁃guided fine⁃needle aspiration/biopsy (EUS⁃FNA/B) has become an important tool in the diagnosis and treatment for diseases of digestive tract and adjacent organs. Meanwhile, the standardization in clinical practice of EUS⁃FNA/B becomes an urgent need. The guideline presented herein is a simplified version of the recently launched Chinese guideline for the clinical practice of EUS ⁃ FNA/B, which is based on the existing domestic and international guidelines and makes substantial updates on frontier progresses in this field in the past few years. A total of 21 clinical concerns and 37 recommendations are proposed in regard to the indications and contraindications, operative skills and techniques, specimens processing, perioperative management, and training and education of EUS ⁃ FNA/B. This guideline would be helpful in directing the clinical application of EUS⁃FNA/B.
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Objective:To evaluate the clinical application value of endoscopic ultrasonography (EUS) in the etiological diagnosis of patients initially diagnosed with idiopathic acute pancreatitis (IAP).Methods:Clinical data of 128 patients who underwent further EUS and magnetic resonance cholangiopancreatography (MRCP) after initial diagnosis of IAP at the Gastrointestinal Endoscopy Center of the First Affiliated Hospital of Naval Medical University between January 2015 and February 2022 were collected and divided into a single-episode group (single-episode group, 51 cases) and a multiple-episode group (recurrent group, 77 cases) based on the number of AP episodes. The data and the diagnosis of the etiology of IAP in the two groups by EUS were analyzed and compared with the etiological diagnosis results of MRCP.Results:The differences on basic information such as gender, age, history of smoking, history of alcohol consumption, family history of pancreatic disease, history of cholecystectomy, abnormality of liver function, and severity of pancreatitis between the single-episode group and recurrent group of IAP patients were not statistically significant. The etiology was clarified in 79 (62%) IAP patients after EUS examination, of which 55 (43%) cases had biliary disease (gallstones, microlithiasis, biliary sludge) and 24 (19%) cases had pancreatic disease (chronic pancreatitis, pancreatic divisum, pancreatic interstitial or pancreatic ductal changes). The percentage of patients with biliary disease as the cause of IAP was significantly higher in the single-episode group than in the recurrent group (59% vs 32%), while the percentage of patients with pancreatic disease as the cause of IAP was higher in the recurrent group than in the single-episode group (25% vs 10%), with statistically significant differences ( P values=0.004 and 0.035, respectively). The performance of EUS in diagnosing the etiology of IAP was significantly higher than that of MRCP (62% vs 19%, P=0.032), where EUS was more accurate in detecting biliary microlithiasis or biliary sludge (43% vs 9%, P<0.01). EUS was also superior to MRCP in identifying subtle changes in chronic pancreatitis lesions (small pancreatic nodules, patchy hyperechogenicity, etc.) and intraductal papillary mucinous neoplasms(17% vs 7%, P<0.05), but was inferior to MRCP in identifying pancreatic divisum (2 cases vs 4 cases). Conclusions:In view of high diagnostic accuracy and safety of EUS in diagnosing biliary diseases, and based on the fact that most IAPs in China are due to biliary diseases, EUS based management strategy can be considered to be a reasonable approach for evaluation of IAP patients. The MRCP can be used as a supplement to the EUS to identify a controversial etiology.
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Objective:To explore the diagnostic value of endoscopic ultrasonography (EUS) for pancreatic cystic lesions (PCLs).Methods:Clinical data of 211 patients with PCLs, who underwent EUS at least once and were pathologically confirmed in First Affiliated of Naval Medical University from January 2011 to December 2021 was retrospectively analyzed. EUS imaging characteristics, biochemical analysis of cystic fluid and pathological data were recorded. The pathological diagnosis results of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms were included in the mucinous lesion group, while pancreatic pseudocyst, serous cystic neoplasms, solid pseudopapillary neoplasms and pancreatic neuroendocrine tumors were included as non-mucinous lesions group; those with pancreatic ductal adenocarcinoma, adenocarcinoma or with atypical or cancer cells were included as malignant lesion group, and the else were included as benign lesions group. The level of CEA in cyst fluid between mucinous and non-mucinous lesions and the level of amylase in cyst fluid between benign and malignant lesion groups were compared, and the area under the curve (AUC) was calculated by drawing receiver operating characteristic curve (ROC), which was used to analyze the differential diagnosis efficiency of cyst fluid CEA and amylase test indexes. The basic characteristics and EUS imaging characteristics, and the diagnostic efficiency of EUS and liquid-based cytology and histopathology between benign and malignant lesions were studied and analyzed.Results:Among the 211 PCL patients, cyst fluid was obtained in 201 patients, of which 188 patients (93.5%) underwent cytological examination, and 33 patients were diagnosed with an accuracy rate of 17.6%; 41 cases were obtained for histological examination, and 23 cases were confirmed, with an accuracy rate of 56.1%. Among all confirmed cases, 45 cases had benign lesions, including 22 cases of mucinous lesions and 23 cases of non-mucinous lesions, with the cyst fluid CEA of 1458.16(19.80, 1500.00), 4.4(0.50, 341.14)ng/ml respectively, and the difference of cyst fluid CEA level between mucinous and non-mucinous lesions was statistically significant( P<0.05). The cyst fluid CEA<10.15 ng/ml could be used to diagnose non-mucinous PCLs with the sensitivity of 89.5%(95% CI0.686-0.981), and the specificity of 66.7%(95% CI0.438-0.837). The cyst fluid amylase levels in benign and malignant lesions were 379.00(50.00, 18405.50), 42.00(13.50, 340.00)U/L, and the difference was statistically significant ( P<0.05). The cyst fluid amylase>747.50 U/L might help to identify benign PCLs with the sensitivity of 91.7%(95% CI0.646-0.996), and the specificity of 48.0%(95% CI0.300-0.665). EUS showed that the proportion of cyst wall thickening, main duct dilatation and cystic solid components in patients with malignant lesions was significantly higher than that in patients with benign lesions, and the differences were statistically significant ( P<0.05), while there was no significant difference in the proportion of cyst wall nodules and cystic septum between the two groups. The accuracy of EUS combined with liquid-based cytology or histopathology in malignant lesions was over 80%. Conclusions:The cyst fluid CEA level can help to differentiate non-mucinous PCLs from mucinous PCLs, and the cystic amylase level could be useful to identify the benign and malignant PCLs. EUS combined with cytology or histology had high diagnostic value for malignant or potentially malignant PCLs, and EUS-FNA examination can be recommended as soon as possible for those with high-risk factors.
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Objective:To evaluate diagnostic value of contrast-enhanced harmonic endoscopic ultrasonography (CEH-EUS) for pancreatic cystic lesions.Methods:Endoscopic and clinical follow-up data of patients with pancreatic cystic lesions diagnosed by EUS in Department of Gastroenterology of the First Affiliated Hospital of Naval Medical University with CEH-EUS video from March 2013 to April 2020 was retrospectively analyzed.Results:A total of 36 patients were included. There were 16 cases of serous cystadenomas (SCA), 10 cases of mucinous cystic neoplasm (MCN), 5 cases of intraductal papillary mucinous neoplasms (IPMN, 3 with complex type, 2 with main pancreatic duct type) and 5 cases of pancreatic pseudocyst (PPC). 87.5%(14/16) of SCA and 86.7%(13/15) of MCN+ IPMN had hyperenhanced cystic wall with obvious peak and similar washout as surrounding tissue, whereas only 20%(1/5) PPC had hyperenhanced cystic wall. The hyperenhancing effect of PPC was significantly lower than that of SCA and MCN+ IPMN ( P=0.0035 and P=0.0048, respectively ). Mural nodules were detected in 17 cases of pancreatic cystic lesions by EUS, of which 3 cases had hyperenhanced mural modules and 14 cases had hypoenhanced mural nodules by CEH-EUS. Patients showing hyperenhanced mural modules were all finally diagnosed as pancreatic malignancy (1 IPMN, 2 MCN), and the accuracy was 100%. Conclusions:CEH-EUS can have a obvious advantage of differentiating pseudocyst and other pancreatic cystic lesions, while not very useful for differentiating SCA and MCN. Pancreatic cystic lesions showing hyperenhanced mural nodules under CEH-EUS may imply malignancy potential.
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The diagnostic rate of pancreatic cystic lesions (PCLs) is increasing year by year with the development of radiological techniques. PCLs are a group of heterogeneous diseases, mainly including intraductal papillary mucinous neoplasms, mucinous cystic neoplasm, serous cystic neoplasm, and other rare cystic lesions, and different types of pancreatic cystic neoplasms have different biological behaviors and rates of malignant transformation. A precise diagnosis of patients with pancreatic cystic neoplasms helps to select surgical treatment for some patients and perform follow-up observation for other patients. Endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration play an important role in the diagnosis and differential diagnosis of PCLs. Endoscopic ultrasound-guided ablation therapy for PCLs is still in the early stage although it has been performed for more than a decade; however, it is safe and effective and can be used as an substitutive therapy for surgical operation, and therefore, it holds promise for clinical application.
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The development of endoscopic ultrasonography (EUS) examination technology provides a new means for the diagnosis and treatment of pancreatic diseases, but how to form an objective and efficient diagnosis and treatment method is still a hot and difficult focus in EUS research. In recent years, artificial intelligence technology has developed rapidly and penetrated into various fields of medicine. Previous research suggests that artificial intelligence can be used to assist in detecting images for accurate and rapid EUS diagnosis. By adopting different classification models and combining different ultrasound methods, artificial intelligence has achieved high sensitivity and specificity in the diagnosis of various pancreatic diseases, and can be applied to the prognosis evaluation of patients with pancreatic tumor after treatment. In the future, the development of artificial intelligence in the EUS field will surely take root in the specialized segmentation field.
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Objective To evaluate the clinical value of endoscopic retrograde pancreatic drainage ( ERPD) in patients with pancreatic fistula. Methods Data of 42 patients with pancreatic fistula, who were treated with ERPD at Changhai Hospital and Henan Provincial People's Hospital from June 2013 to September 2018,were collected. The pancreatic fistula curative rate, healing duration of pancreatic fistula, and the incidence of complications were analyzed. Results Among 42 patients with pancreatic fistula,there were 30 males(71. 4％) and 12 females(28. 6％) with mean age of 41. 5±12. 8 years old. Pancreatic duct stents of 37 cases ( 88. 1％) went across the fistula. The overall curative rate was 90. 5％( 38/42 ) . The median healing duration of pancreatic fistula was 32. 0 d (8-183 d). The healing time of pancreatic fistula after injury(19. 0±9. 9 d,t=3. 50,P=0. 002) and of pancreatic fistula after surgery(20. 3±10. 7 d,t=3. 35, P=0. 003) were shorter than that of pancreatic fistula after acute severe pancreatitis (60. 0±48. 6 d). The healing time of pancreatic fistula with pancreatic pseudocysts was longer than that of pancreatic fistula without pancreatic pseudocysts (65. 3±55. 4 d VS 32. 6±23. 6 d, t=2. 21,P=0. 040). There were no significant differences in pancreatic fistula curative rate, pancreatic healing duration and times of ERCP in pancreatic fistula at different position. Postoperative stent-related complications occurred in 2 patients ( 4. 8％) , and 1 patient (2. 4％) developed mild pancreatitis. Conclusion ERPD is an important treating method with good therapeutic effect and low complications for pancreatic fistula.
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Objective To explore the effectiveness of endoscopic ultrasound( EUS)-guided holmium laser ablation for primary pancreatic implantation tumor in nude mice. Methods Pancreatic cancer cell line SW1990 were implanted into 204-6-week-old male balb/c nude mice to establish primary pancreatic implantation tumor in situ models. Then the nude mice were randomly divided into two groups, the treatment group(n=10) and the control group(n=10). The treatment group underwent EUS-guided holmium laser ablation in the pancreatic tumor. And no interventions were given to the control group. The volume of tumors of the two groups were measured under EUS at time points of 7 d, 14 d and 28 d after ablation. The activities, appetites and psychosis of all nude mice were evaluated in the meantime. At 28 d after ablation, lesions of pancreas were dissected and sliced for H&E staining. Results There were no complications in the treatment group, and all nude mice could tolerate the procedure. The mental state, activities and appetites of nude mice in the experimental group were better than those in the control group. Tumors of the control group enlarged. There was significant difference in the tumor size between the two groups at 28 d after ablation. HE staining showed coagulation necrosis in the ablation area. Conclusion EUS-guided holmium laser, producing coagulative necrosis in the ablation area, is effective for primary pancreatic implantation carcinoma in nude mice for about 28 days.
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Objective To evaluate the efficacy and safety of a novel lumen-apposing metal stent (LAMS) in endoscopic ultrasonography(EUS)-guided transgastric drainage of pancreatic fluid collections (PFC). Methods A retrospective study of 46 patients was performed who underwent EUS-guided transgastric drainage of PFC with placement of LAMS from September 2015 to April 2017. Clinical data were reviewed and follow-up data were obtained by telephone and outpatient contact. Results A total of 49 LAMS were placed in 46 patients ( 2 LAMS were placed in 3 patient respectively for multiport access ) . The operation success rate was 95. 9％( 47/49 ) , complications occurred in 14 patients ( 31. 8％) , including 2 severe complications ( delayed hemorrhage and peritonitis ) . Additional intervention was performed in 10 patients(22. 7％). The mean hospital stay was 6 days (1-40 days) and patients were followed for a mean time of 18. 4 months ( 9-28 months) . Treatment success was achieved in 40 patients( 90. 9％) . Stent removal was performed after a mean time of 59. 4 days ( 20-142 days) , and recurrence rate was 10％( 4/40) during the follow-up period. Conclusion Drainage of PFC using LAMS with special design is effective and relatively safe.
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Objective@#To evaluate the efficacy and safety of a novel lumen-apposing metal stent(LAMS) in endoscopic ultrasonography(EUS)-guided transgastric drainage of pancreatic fluid collections(PFC).@*Methods@#A retrospective study of 46 patients was performed who underwent EUS-guided transgastric drainage of PFC with placement of LAMS from September 2015 to April 2017. Clinical data were reviewed and follow-up data were obtained by telephone and outpatient contact.@*Results@#A total of 49 LAMS were placed in 46 patients (2 LAMS were placed in 3 patient respectively for multiport access). The operation success rate was 95.9%(47/49), complications occurred in 14 patients(31.8%), including 2 severe complications (delayed hemorrhage and peritonitis). Additional intervention was performed in 10 patients(22.7%). The mean hospital stay was 6 days (1-40 days) and patients were followed for a mean time of 18.4 months (9-28 months). Treatment success was achieved in 40 patients(90.9%). Stent removal was performed after a mean time of 59.4 days (20-142 days), and recurrence rate was 10%(4/40) during the follow-up period.@*Conclusion@#Drainage of PFC using LAMS with special design is effective and relatively safe.
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Objective To investigate factors affecting ampullary access of endoscopic retrograde cholangiopancreatography (ERCP) in patients undergoing Billroth Ⅱ gastrectomy.Methods A retrospective analysis was performed on data of 261 patients with Billroth Ⅱ gastrectomy who underwent ERCP at Changhai Hospital from January 2008 to December 2017.Multivariate logistic regression analysis was used to analyze the potential factors affecting successful ampullary access,and receiver operating characteristic (ROC) curve was used to assess the predictive ability of potential factors.Results A total of 345 ERCP sessions were collected.The successful ampullary access and cannulation rate were 82.3％ (284/345) and 89.1％ (253/284),respectively.The main reasons for ERCP procedural failure were unable to reach the duodenal blind end and find the papilla (66.3％,61/92) and failure of selective cannulation (33.7％,31/92).The ERCP-related complication rate was 14.2％ (49/345),with post-ERCP pancreatitis rate was 3.2％ (11/345).Multivariate logistic regression analysis indicated that the first ERCP attempt (OR=7.717,95％CI:2.581-23.068.P＜0.001),with Braun anastomosis (OR =8.737,95％CI:2.479-30.797,P =0.001),and no cap-assisted forward-viewing gastroscope (OR =2.774,95％ CI:1.283-5.997,P=0.009) were independent risk factors for failure of ampullary access.According to the B value of each risk factor in logistic regression analysis,that is,no cap-assisted as 1 point,the first ERCP attempt as 2 points,and Braun anastomosis as 2 points,the area under ROC curve was 0.773.When the cut-off point was 2.5,the sensitivity and specificity were 75.0％ and 70.8％,respectively.Conclusion The first ERCP attempt,with Braun anastomosis,and no cap-assisted forward-viewing gastroscope are risk factors for failure of ampullary access of ERCP in Billroth Ⅱ gastrectomy patients.Early identification of high-risk patients may help to improve the success rate of ampullary access.
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Conventional imaging examinations including transabdominal ultrasound,computerized tomography,and magnetic resonance ima-ging which have certain limitations in diagnosis of pancreaticobiliary diseases. Endoscopic techniques can scan gallbladder,bile duct and pancreas with high resolution images from which obtained close to digest track. Therefore,they play an important role in diagnosis of pancre-aticobiliary diseases. The rapid development of new techniques including endoscopic retrograde cholangiopancreatography,endoscopic ultra-sound,intraductal ultrasound,and SpyGlass Direct Visualization System help improving the diagnosis accuracy of pancreaticobiliary disea-ses. The article reviews the application of new endoscopic techniques in pancreaticobiliary diseases.
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Objective To evaluate technical feasibility, safety and efficacy of endoscopic ultrasound-guided ethanol ablation (EUS-EA) for pancreatic cystic neoplasms (PCNs). Methods Clinical data of 10 patients with PCNs in Changhai Hospital from July 2013 to April 2017, including demographic information, EUS features, adverse events and follow-up data, were retrospectively studied. Efficacy was assessed according to imaging data.Results The mean largest diameter of the cyst was 2. 95±1. 56 cm.Cyst fluid analysis showed that there were 6 serous cystic neoplasms, 3 mucinous cystic neoplasms, and 1 indeterminate cyst. Totally 12 operations were performed successfully. No infection, pancreatitis, bleeding, pancreatic fistula or other severe complications with clinical significance occurred. The median follow-up time was 4. 0 months ( 3. 0-12. 0 months ). Three patients achieved complete resolution, 6 achieved partial resolution, 1 was stable disease, and no patient showed progressive tumor. Conclusion EUS-EA for PCNs has high operation success rate, less complication and satisfactory overall efficacy.
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Objective To assess the value of carcinoembryonic antigen (CEA) level,liquid based cytology examination and combining 2 methods in predicting advanced pancreatic cystic neoplasms (PCNs).Methods The clinical data of 78 patients pathologically confirmed with PCN who underwent surgical resection after EUS-FNA and cyst fluid analysis in Shanghai Changhai Hospital,from January 2006 to June 2017 were collected and analyzed,including 32 (A-PCNs) patients and 46 non A-PCNs patients.The comparisons on the CEA level in the cyst fluid and liquid based cytology between the two groups were performed.ROC curve for CEA level in cyst fluid was applied and under curve area was calculated.Sensitive,specificity and accuracy were applied to assess the diagnosis value of 2 methods in predicting A-PCNs.Results In 35 patients,the difference on cyst fluid CEA level was statistically significant between 9 A-PCNs and 26 non A PCNs patients) [(1419.9 ± 1416.9) μg/L vs (316.0 ± 475.2) μg/L,P =0.049].Based on ROC curve,CEA ＞ 418.9 ng/ml could help to predicting A-PCNs with the sensitivity of 85.7％,specificity of 73.1％,and accuracy of 75.8％ as the cutoff value,and the area under ROC curve was 0.863.Liquid based cytology were performed in 27 A-PCNs patients and 33 non A PCNs patients,and the positive rate had statistical difference between 2 groups (48.1 vs 9.1％,P =0.001).The sensitivity,specificity and diagnostic accuracy for liquid-based cytology for diagnosing A-PCNs were 48.1％,90.9％,and 55.1％.Cyst fluid CEA combined with liquid based cytology can effectively diagnose A-PCN,and the sensitivity,specificity,and diagnostic accuracy were 100％,64.7％ and 76.0％.Conclusions Liquid-based cytology and cyst fluid CEA level were useful in predicting A-PCNs to a certain degree.Combining 2 methods could improve the sensitivity and accuracy in predicting A-PCNs.
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Objective To evaluate the factors influencing the diagnostic positivity of endoscopic ultrasonography guided fine needle aspiration (EUS-FNA) for small size pancreatic carcinoma (SSPC) and the occurrence of the adverse events after the aspiration.Methods 51 patients with SSPC ≤2 cm in diameter treated in Changhai hospital from February 2008 to January 2015 were retrospectively studied.The gender,age,tumor diameter,location,the dilation of pancreatic ducts,the number of aspirations and the needle passages,the usage of negative pressure during aspiration,the pathological examination of the specimens and postoperative adverse events and the like were collected.Univariate analysis and logistic regression analyze were applied to determine the factors influencing the diagnostic positivity of EUS-FNA for SSPC and postoperative adverse events.Results Among the 51 patients,positive cytology outcome were identified in 30 patients,which were negative in 21 patients.Univariate analysis identified that there were no statistical differences on the age,sex,dilated pancreatic duct,the number of aspirations and needle passages between two groups (P value ＞0.05).The diagnostic positivity using the 10ml minor negative pressure was obviously higher than that using 20 ml negative pressure,and the differences were statistically significant (P =0.028).Multivariate logistic regression identified 10ml minor negative pressure was easier to obtain positive cytology outcome (Odds Ratio 0.2810,95％ CI 0.093-0.851).In addition,the number of passages in patients with postoperative adverse events was greater than those without postoperative adverse events (30 vs 20),and the difference was statistically significant (P =0.034).Conclusions The introduction of 10 ml negative pressure could improve the diagnostic positivity of EUS-FNA for SSPC,and the increased number of needle passages may increase the occurrence rate of postoperative adverse events.
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Objective To evaluate the efficacy of endoscopic ultrasonography-guided celiac plexus radiation with iodine-125 (125I) seeds and celiac plexus neurolysis with absolute ethanol for pain relief secondary to advanced pancreatic cancer.Methods A retrospective analysis of 43 patients of advanced pancreatic cancer with moderate to severe abdominal pain in the Department of Gastroenterology,Shanghai Changhai Hospital from January 2017 to April 2018 was performed.20 patients underwent EUS-guided celiac plexus neurolysis (CPN),and 23 patients underwent EUS-guided celiac plexus radiation (CPR) with the implantation of 125I seeds around the celiac ganglia.The postoperative VAS score of abdominal pain,mean analgesic (MS Contin [morphine sulfate]) consumption and complications were compared between the two groups.Results There were no statistically significant differences between the two groups in the sex ratio (male/female,10/10 vs 14/9),average age [(64 ± 11) vs (64 ± 12)],lesion location (head/tail,7/13 vs 8/15] and TNM stage (Ⅲ/Ⅳ,9/11 vs 7/16),and the two groups were comparable.Compared with preoperative ones,the VAS score (3.0 points vs 5.5 points) and morphine dosage (30 mg vs 52.5 mg) were significantly lower in the CPN group one week after operation.In the CPR group,the VAS score (5.0 points vs 6.0 points) and morphine dosage (50 mg vs 55 mg) at 2 weeks after the operation were lower than those before the operation;the VAS scores of 4,8 and 12 weeks after the operation decreased to 3.0 points,and the dosage of morphine decreased to 30 mg,25 mg and 30 mg,respectively.The differences were statistically significant (P＜0.0001).Compared with the CPR group,at 2 weeks postoperatively the CPN group demonstrated a significantly higher decrease of VAS score (3.0 points vs 2.0 points),degree of morphine reduction (30 mg vs 10 mg) and rate of partial pain relief (70.0％ vs 4.3％).However,from 4 to 12 weeks postoperatively,the decrease in VAS score,the decrease in the dosage of MS Contin and the rate of partial pain relief in the CPR group were all significantly higher than those in the CPN group (P ＜ 0.05).There was no complete relief of pain in the two groups.No procedure-related deaths or serious complications were observed and only mild gastrointestinal adverse reactions occurred.Conclusions Two methods can both relieve abdominal pain in patients with advanced pancreatic cancer safely and effectively.CPR takes effect late but has advantages of good extent and long duration of pain relief.
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Objective To investigate the predictors for the preoperative diagnosis of pancreatic mucinous cystic neoplasm with invasive carcinoma (MCN-IC).Methods Clinical data of 132 patients with pancreatic mucinous cystic neoplasm ( MCN ) who underwent surgery and were pathologically diagnosed in Shanghai Changhai Hospital and General Hospital of Xinjiang Military Region from August 2000 to December 2013, including gender, age, medical history, clinical presentations, laboratory examinations and imaging findings and etc , were retrospectively analyzed .All cases were classified into two groups:MCN with noinvasive carcinoma ( MCN-nIC, including MCN with low-or intermediate-grade dysplasia and MCN with high-grade dysplasia ) and MCN-IC.The univariate and multivariate logistic regression was used to analyze the differences on laboratory examinations and imaging findings and the like to identify the predictors for the preoperative diagnosis of MCN-IC.Receiver operator characteristic ( ROC) curve was used to evaluate fitting performance and Hosmer-Lemeshow test was performed to evaluate goodness of fit .Results Of the 132 patients, 115 (87.12％) were MCN-nIC, 17(12.88％) were MCN-IC.Univariate analysis identified old age(≥60 years), abdominal pain, anorexia, GLU elevated, CEA≥5 ng/ml, CA19-9≥37 U/ml, unclear border of tumor , thick wall (>2 mm) , presence of mural nodules and absence of the septa as independent predictors for MCN-IC. Multivariate analysis identified old age (≥60 years), abdominal pain, CA19-9≥37 U/mL, unclear border of tumor, presence of mural nodules and absence of the septa as the predictors for MCN -IC.The maximal area under ROC ( AUC) was 0.947, which indicated that the fitting performance of the model was satisfactory and the goodness of fit was better (P=0.056).Conclusions MCN-IC had a generally low prevalence .Old age (≥60 years), abdominal pain, CA19-9≥37 U/ml, unclear border of tumor, presence of mural nodules and absence of the septa may predict the diagnosis of MCN-IC.