Cap-Assisted Technique versus Conventional Methods for Esophageal Food Bolus Extraction: A Comparative Study

BACKGROUND/AIMS: Food bolus impaction is the most common form of esophageal foreign body impaction observed in adults. Clinical guidelines recommend using the push technique or retrieval methods in such cases. The push technique can cause injuries in certain clinical situations. Notably, conventional retrieval methods are time and effort consuming. Cap-assisted endoscopic extraction of an impacted food bolus is an easy and effective technique; however, more data are needed for its validation. This study compared the capassisted extraction technique with conventional methods. METHODS: This prospective observational multicenter study compared the success and en bloc removal rates, total procedure time, and adverse events in both techniques.. RESULTS: The study included 303 patients who underwent food bolus extraction. The push technique was used in 87 patients (28.7%) and a retrieval procedure in 216 patients (71.3%). Cap-assisted extraction was performed in 106 patients and retrieval using conventional methods in 110 patients. The cap-assisted technique was associated with a higher rate of en bloc removal (80.2% vs. 15%, p<0.01), shorter procedure time (6.9±3.5 min vs. 15.7±4.1 min, p<0.001), and fewer adverse events (0/106 vs. 9/110, p<0.001). CONCLUSIONS: Cap-assisted extraction showed no adverse events, higher efficacy, and a shorter procedure time compared with conventional retrieval procedures.

Role of spiral CT scan and endoscopic ultrasonography in assessing operability of peri-ampullary tumors

Pancreatic cancer is associated with an extremely poor prognosis with less than 5% of patients surviving 5 years after the diagnosis. Current preoperative staging modalities include various cross sectional imaging techniques. including spiral CT and endoscopic ultrasound [EUS]. This prospective study aimed at demonstrating the role of spiral CT and endoscopic ultrasonography in early diagnosis staging and assessment of operability of periampullary tumors. Sixty-two patients with periampullary tumors were included in this study. All cases were subjected to abdominal ultrasound. Spiral CT. ERCP. EUS and operative interference. Surgical findings were considered the gold standard for assessing the sensitivity of spiral CT and EUS in diagnosing, staging arid estimating resectability of periampullary tumors. Endoscopic Ultrasonography was very sensitive in detecting periampullary masses [93.5%] especially masses smaller than 20mm while the sensitivity of spiral CT was 71%. EUS was also very sensitive in detecting ampullary masses [100%] in contrast to spiral CT chat missed the diagnosis of the 14 ampullary masses found in our work. EUS was more sensitive than Spiral CT in detecting malignant vascular invasion [95% versus 75%] while it was slightly less specific than spiral CT in that context [74 versus 80%]. The predictive value of spiral CT was 60% for tumor resectability while it was 100% for tumor unresectability. The predictive value of EUS was 735% for tumor resectability while it was 96.4% for tumor unresectability. When combining both techniques the predictive value for tumor resectability was 65% while it was 100% for tumor unresectability. No complications were encountered in both techniques. We concluded that EUS is more sensitive than spiral CT in detection and staging of periampullary masses. Also. the non-invasive spiral CT and the minimally invasive EUS are very valuable tools in predicting uresectability of periampullary masses while EUS is slightly more valuable in detecting tumor resectability

Role of ultrasound guided fine needle biopsy, EUS and serum CA19-9 level in diagnosis of pancreatic masses

Pancreatic Cancer is a very aggressive tumor with an extremely poor prognosis. Early diagnosis, accurate preoperative staging and better adjuvant treatment remain a challenge. Abdominal ultrasound, abdominal CT, EUS and ERCP are common tools used for imaging of pancreatic cancer. Fine needle aspiration has made significant contribution to the diagnosis of cancer pancreas. The aim of the present work was to evaluate the role of ultrasound guided fine needle aspiration cytology [FNAC] in the diagnosis of pancreatic masses and in the differentiation of cancer pancreas from benign lesions. In addition to that, the level of serum CA 19-was measured to assess its accuracy in differentiating cancerous from benign lesions. This cross sectional study included forty patients with pancreatic lesions. They were subjected to full clinical examination, laboratory tests [including serum level CA 19- 9], abdominal ultrasound, percutaneous sonar guided FNAC of pancreatic lesions, endosonography and surgical interference [was done to 32 patients]. Thirty three patients proved to have pancreatic malignancy while seven patients proved to have pancreatitis. Ultrasonography [US] showed a sensitivity of 70%, specificity of 86% and accuracy of 73% for malignancy detection. Adding CAI9-9 to ultrasound raised the sensitivity to 94%, specificity remained 86% and accuracy to 93%. Adding FNAC to US raised the sensitivity to 85%, specificity remained 86% and accuracy to 91%. EUS showed a sensitivity of 90%, specificity of 100% and accuracy of 91%. Adding CA to EUS showed a sensitivity of 94%, specificity of 100% and accuracy of 91%. Adding FNAC to EUS showed a sensitivity of 97%, specificity of 86% and accuracy of 97%. The combination of EUS, serum CAI9-9 level and sonar guided fine needle aspiration showed an accuracy of 97% in the diagnosis of pancreatic lesions. These investigatory tools are cheap and available and thus may be an excellent alternative to EUS guided fine needle aspiration which is expensive and available in only a few centres