ABSTRACT
With the development of endoscopic techniques,the recent emergence of additional techniques of endoscopic ultrasound (EUS) have provided a novel means for the diagnosis and treatment of pancreatic tumors,which has received more and more attention and recogni-tion from around the world.This article reviews the progress in additional new techniques of EUS in the treatment of common pancreatic tumors.Finally,we can conclude that the additional techniques of EUS have high therapeutic values for pancreatic tumors.
ABSTRACT
Objective To explore the feasibility of using digital imaging processing (DIP)to extract EUS image parameters for the differential diagnosis of autoimmune pancreatitis (AIP)and chronic pancreati-tis (CP).Methods A total of 81 patients with AIP and 100 patients with CP diagnosed from May 2005 to January 2013 were recruited to this study.A total of 105 parameters of 9 categories were extracted from the region of interest by using computer-based techniques.Then the distance between class algorithm and se-quential forward selection (SFS)algorithm were used for a better combination of features.A support vector machine (SVM)predictive model was built,trained,and validated.Results Overall,25 parameters of 5 categories were selected as a better combination of features when the incidence of accurate category was max (90.08%).A total of 181 sample sets were randomly divided into a training set and a testing set by using two different algorithms and 200 random tests were performed.The average accuracy,sensitivity,specificity, the positive and negative predictive values of AIP based on the half-and-half method were (86.04 ± 3.15)%,(83.66 ±6.57)%,(88.54 ±4.37)%,(85.96 ±4.44)% and (87.12 ±4.39)%,respective-ly.Conclusion Computer-aided diagnosis of EUS images is objective and non-invasive,which can improve the accuracy in differentiating AIP from CP.This technology provides a new valuable diagnostic tool for the clinical determination of AIP.
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The differential diagnosis of pancreatic head mass has been clinical difficulties.Endoscopic ultrasonography is now recognized as one of the sensitive and effective methods for the diagnosis of pancreatic diseases.This paper discusses the diagnostic performance of endo-scopic ultrasonography for various common types of pancreatic head mass,as well as the radiological features of this disease,reviews the di-agnostic value and safety of endoscopic ultrasonography-guided fine needle aspiration for pancreatic head mass,and briefly introduces the advances in the application of additional new techniques of endoscopic ultrasonography for this disease.Finally,it is pointed out that endo-scopic ultrasonography has a high diagnostic value for pancreatic head mass.
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Objective To evaluate the diagnostic accuracy of contrast-enhanced harmonic EUS (CH-EUS)for pancreatic cancer.Methods Patients with pancreatic occupying lesion underwent CH-EUS with ultrasonic contrast medium Sonovue.Pathological diagnoses by EUS-FNA or surgery and the follow-up results were made as the final diagnosis to evaluate the accuracy of CH-EUS for pancreatic cancer.Character-istics of CH-EUS in different pancreatic tumors were analysed.Results A total of 76 patients were en-rolled,with an average age of 53. 1 ±14. 2.Thirty-five were finally diagnosed as having pancreatic cancer, 21 local mass-type pancreatitis,10 pancreatic neuroendocrine tumor,6 cystadenoma,4 intraductal papillary mucinous neoplasm.Tumor diameter was 3. 4 ±1. 4 cm and there were 18 less than 2 cm.The sensitivity and specificity,positive and negative predictive value of CH-EUS for pancreatic cancer was 97. 1%, 92. 9%,91. 7% and 97. 5% respectively.The sensitivity was 100% combined with FNA.Conclusion CH-EUS is safe,convenient for pancreatic cancer with high accuracy and can be used as an additional diag-nostic method to EUS-FNA.
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Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for digestive tract mucosal lesions,and risk factor of complications.Methods The data of 154 consecutive patients who underwent ESD for superficial digestive tract mucosal lesions were analyzed prospectively for therapeutic effect and rate of complications.Risk factors for bleeding was analyzed.Results The enbloc resection rate in 145 completed ESD procedures was 100.0％.Histologically,complete resection rate was 99.3％.ESD was not completed in 9 patients due to bleeding ( n =5) and perforation ( n =4).Acute massive bleeding occurred in 6 patients (6/154,3.9％),mild bleeding in 5 (3.2％),delayed bleeding in l (0.6％ ),perforation in 4 (2.6％ ) and post-ESD stenosis in 1 (0.6％ ).All complications were cured.The post-ESD ulcer-healing was achieved in 100％ at 8 weeks after treatment.During follow-up of 10.6months( ranged from 8 to 18 months),no residual or local recurrence was found.Statistic analysis showed independent risk factors for bleeding in ESD were lesion location (cardiac fundus),and lesion size.Conclusion ESD is an effective and safe procedure in treatment of digestive tract mucosal lesions.The complications of ESD are preventable and curable.Strictly controlling operation indications,individualized treatment and the proficient operation skills of physicians are the keys to success.