ABSTRACT
Summary Necrotizing pancreatitis with fluid collections can occur as a complication of acute pancreatitis. The management of these patients depends on the severity and involves multiple medical treatment modalities, as clinical intensive care and surgical intervention. In this article, we show a severe case of walled-off pancreatic necrosis that was conducted by endoscopic drainage with great clinical outcome.
Resumo Pancreatite necrosante com coleções pode ocorrer como complicação da pancreatite aguda. O manejo desses pacientes depende da gravidade e envolve múltiplas modalidades médicas de tratamento, como terapia clínica intensiva e intervenção cirúrgica. Neste artigo, mostramos um caso grave de necrose pancreática com ótima resolução clínica após drenagem endoscópica.
Subject(s)
Humans , Female , Adult , Drainage/methods , Endoscopy, Digestive System/methods , Pancreatitis, Acute Necrotizing/surgery , Pancreatitis, Acute Necrotizing/diagnostic imaging , Plastics , Prosthesis Design , Severity of Illness Index , Tomography, X-Ray Computed , Drainage/instrumentation , Reproducibility of Results , Treatment Outcome , EndosonographyABSTRACT
PURPOSE: To evaluate the diagnosis improvement of EUS-FNA when using ROSE performed by the endosonographer. METHODS: A retrospective study was conducted. A total of 48 pancreatic solid masses EUS-FNA were divided into two groups according to the availability of on-site cytology (ROSE) - the first 24 patients (group A-without ROSE) and the latter 24 cases (group B-with ROSE). Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, complications and inadequacy rate of EUS-FNA were determined and compared. RESULTS: Among the 48 EUS-FNA, the overall performance was: sensitivity 82%; specificity 100%; positive predictive value (PPV) 100%; negative predictive value (NPV) 70% and accuracy 87%. The sensitivity of the Group A was 71%, versus 94% in-group B (p=0.61). Moreover, the negative predictive value was 58% versus 87% (p=0.72). The accuracy rate increased from 79% to 96% (p=0.67) in the ROSE group. The number of punctures was similar between the groups. No major complications were reported. CONCLUSION: Rapid on-site cytopathological examination, even when performed by the endosonographer, may improve the diagnostic performance in the diagnosis of solid pancreatic lesions, regardless of the slight increase in the number of punctures. .
Subject(s)
Humans , Endoscopic Ultrasound-Guided Fine Needle Aspiration/standards , Endosonography/standards , Pancreas/pathology , Pancreatic Diseases/pathology , Adenocarcinoma/pathology , Adenocarcinoma , Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods , Endosonography/methods , Prospective Studies , Pancreas , Pancreatic Diseases , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms , Quality Improvement , Reproducibility of Results , Retrospective Studies , Sensitivity and SpecificityABSTRACT
A gastroenterologia sofreu uma verdadeira revolução com a introdução da endoscopia digestiva, principalmente a partir da década de 1960, com o desenvolvimento de novas técnicas e o aprimoramento do conhecimento científico. A endoscopia digestiva alta (EDA) ocupa um papel muito importante no arsenal diagnóstico e terapêutico na prática médica, em especial graças ao extraordinário avanço tecnológico ocorrido nos últimos anos. Atualmente, é possível avaliar e conduzir de maneira mais precisa as patologias gastrointestinais, entre elas as diversas formas de esofagites, gastrites, lesões pépticas, neoplásicas, vasculares e corpos estranhos, com melhor acurácia diagnóstica e menores complicações. A EDA é o principal e o mais importante método disponível na abordagem da hemorragia digestiva alta (HDA), tanto para o diagnóstico como para a terapêutica, com consequente influência no prognóstico dos pacientes. Além disso, exerce papel fundamental na avaliação e retirada dos corpos estranhos no trato digestivo, reduzindo de forma importante a morbimortalidade dos indivíduos acometidos por essa comorbidade. Com base nisso, o objetivo desse estudo é mostrar os resultados encontrados nos exames de EDA, realizados em âmbito ambulatorial ou emergencial, em um centro de treinamento em endoscopia digestiva.
Gastroenterology underwent a revolution with the introduction of endoscopy, mainly from the 1960, with the development of new techniques and the improvement of scientific knowledge. Upper endoscopy (EGD) occupies a very important role in diagnosis and therapeutics in medical practice, mainly due to the extraordinary technological advances of recent years. Currently, it is possible to evaluate and conduct more accurately the gastrointestinal disorders, including various forms of esophagitis, gastritis, peptic lesions, neoplastic, vascular, and foreign bodies, most accurate diagnoses and fewer complications. The EDA is the main and most important method available in the approach to upper gastrointestinal bleeding (UGIB), both for diagnosis and for therapy, with consequent influence on the prognosis of patients. Furthermore, plays a fundamental role in the evaluation and removal of foreign bodies in the digestive tract, greatly reducing the morbidity and mortality of individuals affected by this comorbidity. Based on this, the objective of this study is to show the results of EDA exams performed in outpatient or emergency context, a training center for endoscopy.