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Objective To investigate the diagnostic values of imaging techniques and endoscopy in detection the causes of post-hepatic obstructive jaundice.Methods The clinical data of 57 patients with post-hepatic obstructive jaundice were retrospectively studied.The causes of the obstruction and the findings of uhrasonography(US),computerized tomography(CT),magnetic resonance imaging(MRI)or MRIcholangiopancreatography(MRCP),endoscopic retrograde cholangiopancreatography(ERCP)and endoscopic ultrasonography(EUS)were compared.Results The causes of 57 patients with post-hepatic obstruetive jaundice were benign obstruction in 42(including stones in common bile duct in 38,ascariasis of CBD in 1,postoperative stricture in 2 and chronic pancreatitis in 1),and malignant lesions in 15(including pancreatic head carcinoma in 11 and ampullary carcinoma in 4).The diagnostic accuracy in terms of lesion location of US,CT,MRI+MRCP,ERCP and EUS were 71.93%(41/57),88.00%(22/25),94.59% (35/37),100.00%(47/47)and 96.77%(30/31),respectively;the diagnostic accuracy of cause of obstruction were 63.16%(36/57),80.00%(20/25),83.78%(31/37),100%(47/47)and 96.77% (30/31),respectively.Conclusion Benign diseases are the main causes of post-hepatic obstructive jaundice,but malignant ones are not rare.It is important to combine miscellaneous imaging techniques and endoscopy in diagnosis.
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Objective To analyze the characteristics of gastric stromal tumors(GST)under endoseopic ultrasonography(EUS)according to its aggressive risks.Methods The clinical data of 36 patients with GST,who underwent surgery from July 1997 to July 2007,were analyzed retrospectively.All the patients underwent EUS before operation and were classified according to Fleether's 4-tier system to predict the aggressiveness of the tumors.The features of the tumor under EUS including its size,ulceration,border,echo charateristies and growth pattern were recorded and the difference between each tumor group were analyzed by ANOVO and rank sam test.Results The mean maximal diameter of GST Was 7.3 cm(range 1.0-20.0 cm),and the size of tumors with hiisher aggressiveness risk Was significantly larger than that with lower risk(P＜0.01).The mucosal ulceration,obscure border,irregular shape and echo heterogeneity were more commonly seen in the groups with higher risk(P＜0.05).There Was no difference in the internal echo and growth pattern of GST between different groups.Conclusion EUS features are useful in differentiation of the aggressiveness risk of the GST.and guide the management of the tumors.
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Objective To evaluate the diagnosis and management of ectopic pancreas.Methods The clinical data of 62 cases of ectopic pancreas,which were diagnosed by endoscopic uhrasonography (EUS)or pathologic findings between July 2006 and December 2007 were retrospectively analyzed.The cases were divided into 4 groups according to different ways of management.Group A included 37 patients,who were diagnosed as having ectopic pancreas(＜19mm)by EUS only and were followed up via phone call every 3 months.Eight patients in group B were diagnosed by EUS as having submucosal lesions suspected as ectopic pancreas,and underwent operation because of large size or difficulty in diagnosis.Eight patients in group C received operation for other diseases and the eetopic pancreases were found in operation.Group D included 9 patients who underwent surgery due to malignant tumors.ResultsEctopic pancreas were most commonly found as a single lesion in gastric antrum(35/62,56.5%)with mean size of 9.2±5.4 mm.All patients in group A were asymptomatic,of which 10 received followed-up endoscopy and no changes in size of the lesion were found.All patients in group B,C and D were diagnosed as ectopic pancreas pathologically.Conclusion Ectopic pancrea is relatively common and asymptomatic,only part of them could be diagnosed clinically.Carcinoma arising from the ectopic pancreas is rare and lesion of small size diagnosed by EUS could be followed up endoseopieally.
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Objective To evaluate the diagnostic value of endoscopic ultrasonography-guided fineneedle aspiration(EUS-FNA)for pancreatic occupying lesion,especially pancreatic cancer.Methods From year of 2005,37 patients with suspected pancreatic cancer by means of uhrasound,CT or MRI received EUS-FNA.Amylase and tumor markers(CEA,CA19-9 and CA125)in cyst fluid were analyzed if applicable.The patients were followed up till July 2008,and the results of EUS-FNA were compared with those confirmed during the follow-up.Results The EUS-FNA yielded diagnosis of 16 cases of pancreatic duetal adenocarcinoma,1 metastatic:renal cancer,5 suspicious malignancy,6 atypia,6 normal pancreatic tissue,and 3 normal non-pancreatic tissue.During the follow-up,25 cases of pancreatic cancer and 10 benigh lesions,including 4 chronic panereatitis,4 cyst-adenoma and 2 pseudocyst,were confirmed,and the other 2 cases still remained un-determined.The sensitivity,specificity,positive predictive value and negative predictive value of EUS-FNA were 80.0%(95% CI:59.0-93.0),100.0%(95% CI:60.0-100.0),100.0%(95% CI:80.0-100.0),and 55.6%(95% CI:27.0-79.0),respectively.No severe procedurerelated complication was observed.Conclusion EUS-FNA is a safe and effective medality for diagnosis of pancreatic occupying lesions,especially pancreatic cancer.
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Objective To compare the yield of endoscopic ultrasonography guided fine needle aspira-tion (EUS-FNA) with 3 different sample processing methods. Methods The clinical data of 118 patients, who underwent EUS-FNA performed by one physician from February 2005 to September 2008, were retrospectively analyzed. The FNA sample processing methods included liquid-based cytology, on-site cytology and smear method. The pathological diagnosis was classified as definite, suspicious malignancy, dissatisfying sampling and indefinite. Results The success rate of obtaining samples through on-site cytological procedure was 95.2% (40/42), which was significantly higher than that of conventional smear (32/47, 68%, P <0. 05), and was higher than that of liquid-based cytological method (26/29, 89. 7% ), but without significant differ-ence (P>0.05). The yield of definite diagnosis with liquid-based cytology and on-site cytology were 82.8% (24/29) and 78. 6% (33/42), respectively, which were both significantly higher than that of smear method (57. 4%, 27/47, P <0. 05). The sensitivity and accuracy of on-site cytology were higher than those of smear method and liquid-based cytology, but without significant differences (P >0. 05). Conclusion Compared with conventional smear method, an-site cytology and liquid-based cytology yield more results from EUS-FNA.
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Objective The aim of this study is to evaluate the accuracy of EUS in rectal cancer restaging after neoadjuvant therapy. Methods EUS staging was performed after neoadjuvant therapy in 61 patients who were diagnosed as having local advanced rectal cancer. All patients underwent subsequent surgi-cal resection and complete pathologic staging. Results Compared with pathological staging, the total accura-cy of post-therapy EUS T-staging was 59.0% (36/61). The T-overstaging rate was 36.1% (22/61) and un-derstaging rate was 4.9% (3/61). Accuracy of EUS N-staging was 68.9% (42/61), N-overstaging and un-derstaging rates were 14.7% (9/61) and 16.4% (10/61), respectively. Conclusion The accuracy of EUS restaging for rectal cancer after neoadjuvant therapy is relatively low.
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is able to provide pathologic data and achieve the efficacy equivalent to surgery.
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Objective To assess the clinical value of endoscopic uhrasonography(EUS)combined with the mini-probe endoscopic uhrasonography(MPUS)in determing tumor invasion depth and lymph node metastases of early superficial esophageal cancer.Methods One hundred and twenty-four superficial esophageal cancer lesions of 121 patients were staged by EUS combined with MPUS,and the results were finally compared with pathological findings of surgical specimens or samples obtained by mucosal resection.Results The diagnostic accuracy of EUS in T staging of superficial esophageal cancer was 82.3%(102/124).The total ratio of lymph node metastases was 5.0%(6/121),with no node metastases in carcinoma in situ,1.3%(1/28)in mucosal carcinoma,11.6%(5/43)in submucosal carcinoma.Conclusion EUS combined with MPUS is accurate in staging of the superficial carcinoma,which can help the choice of therapeutic strategies.
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Objective To evaluate contrast-enhanced endoscopic uhrasonography(CE-EUS)in the differential diagnosis of pancreatic diseases.Methods Eighteen patients with suspected pancreatic neoplasms and chronic pancreatitis,which would be finally affirmed with EUS-FNA or histophathologic examinations,as well as five normal control subjects were enrolled and underwent CE-EUS by using ultrasonic contrast agent(sonovue,Bracco Co.,Italy).Characteristics of enhancement including form,echo and enhanced blood perfusion of the target areas were investigated in normal pancreas and various diseased ones.Results By CE-EUS,five cases of normal pancreatic parenchyma were presented as punctiform or claviform enhancement pattern with homogeneous distribution(type Ⅰ-Ⅱ);while two chronic pancreatitis cases were presented as claviform or plaquelike enhancement pattern with inhomogeneous distributition(type Ⅱ-Ⅲ).In addition,thirteen pancreatic carcinomas were presented as inhomogeneous punctiform or claviform enhancement(typeⅠ-Ⅱ)partially with border enhancement and with slow enter-in and fast wash-out phase.However,three benign insulinomas were presented as holo-plaquelike enhancement(type Ⅲ),and 2 with fast enter-in and fast washout phase.Besides,different enhancement intensity was identified in different diseases.Conclusion CEEUS,from which different enhancement pattern,phase and intensity would be shown in various pancreas,is a safe and feasible imaging modality in the differential diagnosis of pancreatic diseases.
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Objective To evaluate the diagnostic value of endoscopic ultrasonic elastography in lymph node staging of gastrointestinal tumors.Methods Thirty-nine abdominal lymph nodes and 26 mediastinal lymph nodes of 35 patients with gastric cancer or esophageal carcer were examined by endoscopic ultrasonic elastography of five-point elastic score.Lymph node at 1-3 points was regarded as negative(benign),while 4-5 points as positive(malignant).The diagnostic value of EUS elastography was determined by comparing the results with pathological findings.Results Of all the 65 lymph nodes,49 were diagnosed as positive and 16 negative.The sensitivity and specificity of EUSE in the diagnosis of malignant lymph nodes were 91.1%and 60.0%.respectively.Conclusion EUSE is helpful for diagnosis of malignant metastasic lymph nodes.
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Objective To investigate the diagnostic value of EUS with miniprobe on upper gastrointestinal tract mesenchymal tumor(GIMT).Methods The EUS features of 38 patients with GIMT who underwent EUS with miniprobe were studied retrospectively,and the results were compared with the postoperative pathological findings.Results Among 38 GIMT cases detected by EUS,there were 25 cases of gastrointestinal stromal tumor,11 cases of leiomyoma,and 2 cases of leiomyosarcoma.Postoperative histopathological and immunohistochemical examinations confirmed 28 cases of stromal tumor.In which 6 cases were high-risk GIST,8 cases were leiomyoma,1 case was leiomyosarcoma,and 1 case was neurofibroma.The accuracy of diagnosis with EUS was 89%.Conclusion EUS is an accurate method in diagnosis of submucosal tumors,which can make better differentiation diagnosis between GIMT and other submucosal tumors.
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Objective To analyze the characteristics of EUS imaging in the patients with autoimmune pancreatitis(AIP).Methods Eleven cases of AIP were studied retrospectively,and features of EUS were analyzed.Results EUS revealed diffuse or focal enlargement of pancreas along with hypoechoic parenchyma and a wavy margin.In addition to dilation,the bile duct had a prominently thickened wall with homogenous mild hypoechoic image.Peripancreatic lymph nodes could be enlarged.No pancreatic duct dilation.calcification or cysts were found.No peripheral vessels were involved.Conclusion EUS could demonstrate specific images which is helpful in diagnosis of AIP.
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Objective To assess the safety of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA)of pancreatic lesions.Methods Patients who underwent EUS-FNA of a pancreatic lesion between January 2005 and June 2007were studied retrospectively.Possible risk factors were assessed by using logistic analysis.Results In 119 patients who underwent pancreatic EUS-FNA,mild acute pancreatitis were observed in 1(0.84%)patient after the operation.No complication occurred in 12 patients with regional portal vein hypertension.Nine patients(7.6%)showed hyperamylasemia 3 h after the procedure,rangeing from 197 to 835 U/L,with an average of(327±200)U/L.Blood amylase level kept increasing 24 h postoperatively in 6 cases of the 9.Logistic regression analysis showed past history of acute pancreatitis,gender,needle size,number of puncture,cystic foci,preoperative blood amylase level and location of foci would not possibly be the risk factors of hyperamylasemia.Conclusion Incidence of complications after EUS-FNA is 0.84%,and the occurrence rate of hyperamylasemia is 7.6%,indicating,EUS-FNA is a safe procedure.
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objective To retrospectively evaluate the accuracy of endoscopic ultrasonography (EUS)and CT in preoperative tumor,and nodal metastasis(TN)staging of esophageal carcinoma.Methods TN stages of 87 cases diagnosed with preoperative EUS and CT were compared with postoperative pathological results.No patient underwent radiotherapy or chemotheraphy.The radial echoendoscope was used,and balloon dilation was required in 5 cases with stricture.Results The total accuracy of T staging with EUS was 85.1%.CT could not differentiate Tl from T2.The sensitivity of EUS for N staging was 85.0%,higher than that of CT(60.8%).However,some lymph nodes which were not detected by EUS could be revealed by CT.Accuracy of EUS plus CT in T staging is 85.1%.and that in N staging is 90.8%.Conclusion EUS is the most accurate measure in assessing the depth of tumor invasion,whereas the combination of EUS and CT is capable of an overall evaluation for TNM staging.
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Objective To study on the effectiveness of endoscopic ultrasonography(EUS)in detec- ting insulinoma preoperatively.Methods Fifteen patients with clinical and biochemical signs of insulinoma were examined by EUS using a radial-scanning ultrasound endoscope and abdominal ultrasonography,CT, DSA prior to surgery.The outcome was evaluated on the basis of surgery and examination of the resected specimens.Results Fifteen patients with 16 lesions of insulinoma were identified by surgery and pathology. The aceuraey of diagnosis with EUS was 13/15(86.7%),and that with B-US,CT,DSA was 3/15(20%), 5/15(33.3%),9/14(64.3%)respectively.In the 14 lesions identified by EUS,10 lesions were depicted to be hypoechogenic,1 lesion was isoechogenic and 3 lesions were hyperechogenie.All 14 lesions were well demarcated and surrounded by normal pancreatic tissue.The minimum size of the lesion visualized by EUS was 0.5cm.Ten lesions were correctly detected by EUS with size of 0.5～2.0cm.EUS missed diagnosis in 2 lesions not for their small size.EUS falsely indicated a 10mm lesion from two lesions inside the head of pancreas.One lesion outside the pancreatic tail and one lesion in the pancreatic head were missed by EUS in another case.Conclusion EUS is superior in assessing the location of pancreatic insulinoma than other ima- ging methods such as B-US,CT,DSA.