ABSTRACT
Resumen La endosonografía endoscópica es una alternativa que sirve como guía para la realización de derivaciones biliodigestivas en los casos en los que la colangiopancreatografía retrógrada endoscópica (CPRE) ha fallado. Se han descrito técnicas como la coledocoduodenostomía o coledocoantrostomía guiadas por ultrasonografía endoscópica (USE). Se describe el caso de una paciente de 72 años con adenocarcinoma de páncreas, compromiso portal y de paredes duodenales, en quien se usó la CPRE para intentar una derivación paliativa y fue fallida, por lo cual se realizó la colocación de un stent metálico guiado por endosonografía endoscópica, con adecuada respuesta clínica al tratamiento. En conclusión, el procedimiento es seguro y la endosonografía es una vía alterna efectiva en los casos de CPRE fallidas para lograr derivaciones biliares en casos de obstrucción de la vía biliar de origen maligno.
Abstract Endoscopic endosonography is an alternative to guide biliodigestive shunting in cases where endoscopic retrograde cholangiopancreatography (ERCP) has failed. Techniques such as choledoduodenostomy or choledochoantrostomy guided by endoscopic ultrasonography have been described. This is the case of a 72-year-old patient with pancreatic adenocarcinoma, portal vein and duodenal wall involvement, in whom ERCP to try a palliative shunt failed. Therefore, a metal stent was placed using endoscopic endosonography, with adequate clinical response to the procedure and treatment. It is concluded that the procedure is safe and that endosonography is an effective alternative in cases of ERCP failure to achieve biliary bypass in cases of malignant biliary obstruction.
Subject(s)
Humans , Female , Aged , Pancreas , Referral and Consultation , Bile Ducts , Adenocarcinoma , Cholangiopancreatography, Endoscopic RetrogradeABSTRACT
Accurate preoperative staging of gastric cancer is of great significance for choosing an optimal therapeutic schedule and for evaluating the prognosis. Accurate preoperative preparation can avoid unnecessary treatment and help with selecting optimal treat-ment modalities. In recent years, the preoperative staging of gastric cancer has been greatly improved owing to the use of diagnostic methods such as endoscopic ultrasonography, multi-slice spiral computed tomography, positron emission computed tomography, and staging laparoscopy, among other such modalities. However, all diagnostic methods are associated with advantages and limitations. Thus, a combination of various diagnostic modalities is essential for accurate preoperative staging. This paper reviews the research progress in the aforementioned diagnostic methods for preoperative staging.
ABSTRACT
Objective To study the therapeutic effects of EUS-guided biliary drainage (EUS-BD) using a nitinol fully covered self-expandable metal stents in patients with malignant obstructive jaundice after failed ERCP.Methods From January 2016 to January 2018,all patients with malignant obstructive jaundice who failed ERCP underwent EUS-guided biliary drainage using nitinol fully covered self-expandable metal stent at Affiliated Hangzhou First People' s Hospital,Zhejiang University School of Medicine.The operation success rate,liver functional recovery time,complication rate,length of hospital stay and survival time were observed.Results Of 36 patients who underwent EUS-guided biliary drainage,34 were successfully performed,with 19 through the stomach,and 15 through the duodenum.The operation success rate was 94.4％ (34/36).The liver functional recovery time of the 34 patients were 25.8 ±.6.5 days.One patient developed hemobilia and one cholangitis,both improved after conservative treatment.The total complication rate was 5.6％ (2/36).The hospital stay and survival time were 21.5 ± 4.7 days and 220.5 ± 54.8 days,respectively.Conclusion EUS-BD using nitinol fully covered self-expandable metal stents was a feasible and effective treatment in patients with malignant biliary obstruction after failed ERCP.
ABSTRACT
Squamous cell carcinoma of the pancreas is a rare, uncommon tumor that is characterized by squamous metaplasia of the ductal columnar cells. We report the image findings of a rare case of the pancreatic squamous cell carcinoma associated with chronic pancreatitis.
Subject(s)
Humans , Carcinoma, Squamous Cell , Metaplasia , Pancreas , Pancreatitis, ChronicABSTRACT
PURPOSE: Endoscopic ultrasonography (EUS) is a useful imaging procedure for the diagnosis of submucosal tumors in the stomach. The present study investigated the EUS features of benign and malignant gastrointestinal stromal tumors (GISTs) and assessed differences between the two groups. MATERIALS AND METHODS: Thirty patients with a GIST in the stomach were included in the study (23 benign and 7 malignant GISTs). We compared characteristic EUS findings (tumor size, location of tumor, regularity of the outer margin, echo-heterogeneity, presence of cystic spaces, echogenic foci and mucosal ulceration) between benign and malignant GISTs. RESULTS: Tumor sizes over 40 mm were observed in 85.7% of the malignant and 8.7% of the benign tumors (P=0.000). Intralesional cystic spaces were noted in 71.4% of the malignant and 8.7% of the benign tumors (P=0.003). The outer margin was irregular in 71.4% of the malignant and 8.7% of the benign tumors (P=0.014). 85.7% of the malignant and 13.0% of the benign tumors had an echo-heterogeneity in the tumor (P=0.001). The locations of tumor and the presence of echogenic foci or mucosal ulcerations were not different between the two groups. CONCLUSION: Tumor sizes over 40 mm, intralesional cystic spaces, irregular outer margins, and echo-heterogeneity in the tumor were significantly more frequent in malignant GISTs. EUS can provide informations in differentiating benign from malignant GISTs.
Subject(s)
Humans , Diagnosis , Endosonography , Gastrointestinal Stromal Tumors , Stomach , UlcerABSTRACT
PURPOSE: Endoscopic ultrasonography (EUS) is a useful imaging procedure for the diagnosis of submucosal tumors in the stomach. The present study investigated the EUS features of benign and malignant gastrointestinal stromal tumors (GISTs) and assessed differences between the two groups. MATERIALS AND METHODS: Thirty patients with a GIST in the stomach were included in the study (23 benign and 7 malignant GISTs). We compared characteristic EUS findings (tumor size, location of tumor, regularity of the outer margin, echo-heterogeneity, presence of cystic spaces, echogenic foci and mucosal ulceration) between benign and malignant GISTs. RESULTS: Tumor sizes over 40 mm were observed in 85.7% of the malignant and 8.7% of the benign tumors (P=0.000). Intralesional cystic spaces were noted in 71.4% of the malignant and 8.7% of the benign tumors (P=0.003). The outer margin was irregular in 71.4% of the malignant and 8.7% of the benign tumors (P=0.014). 85.7% of the malignant and 13.0% of the benign tumors had an echo-heterogeneity in the tumor (P=0.001). The locations of tumor and the presence of echogenic foci or mucosal ulcerations were not different between the two groups. CONCLUSION: Tumor sizes over 40 mm, intralesional cystic spaces, irregular outer margins, and echo-heterogeneity in the tumor were significantly more frequent in malignant GISTs. EUS can provide informations in differentiating benign from malignant GISTs.