[Percutaneous endoscopic gastrostomy]

In recent decades, Percutaneous endoscopic gastrostomy [PEG], has changed feeding and care of patients who can not feed orally. This outpatient procedure is done in most of the endoscopy wards and provides care, nutrition and medications for these patients outside the hospital. PEG has rare complications and significantly reduces the cost of care and treatment .With invention of this procedure about 30 years ago in the world's gastrointestinal endoscopy centers, we began PEG procedure in Iran .In our experience, neurological diseases especially cerebrovascular events are the most common indication .But trauma especially traffic accidents and tumors of head and neck and esophagus are other indications. After putting the PEG, the patient should be observe under a team including a gastroenterologist, dietician and experienced nurse. Education of patients and caregivers is essential to reduce complications

[Result and efficacy of endoscopic ultrasound guided FNA in patients with solid pancreatic neoplasm]

Endosonography is a distinct method in evaluating gastrointestinal [GI] structural lesions, particularly in the pancreatobiliary system. This procedure has made a fundamental change in the diagnosis of pancreatic mass lesions through fine needle aspiration [FNA]. This study aims to evaluate the results and efficacy of endosonographic fine needle aspiration [EUS-FNA] in patients presenting with solid pancreatic masses. This was a descriptive, prospective, case series study of patients who presented with solid pancreatic masses to Imam Khomeini Hospital, Tehran, Iran over a one year period [from November 2009-2010] In order to determine false negative cases, patients were followed for 6 to 12 months. A total of 53 patients underwent EUS-FNA with no complications. The results were diagnostic in 46 [87%] cases. The majority of patients were male [68%] and 81% had a mass in the pancreatic head. Cytopathology results revealed 36 [68%] adenocarcinomas, 7 [13%] other malignancies, 3 [6%] benign lesions and 7 [13%] nondiagnostic cases. The frequency of nondiagnostic results was significantly more in masses smaller than 3 cm [6 vs. 1, p < 0.002]. Patients with nondiagnostic results were younger than those with malignant cytopathologies [52 +/- 7.5 vs. 66 +/- 7.5 years, p < 0.001]. Sensitivity, specificity, PPV, NPV and accuracy of EUS-FNA in adenocarcinoma cases were 88%, 100%, 100%, 70% and 90%, respectively. EUS-FNA is an effective and safe procedure in the histopathologic diagnosis of pancreatic tumors