Abdominal ultrasonography in the diagnosis of extrinsic endoscopic compressions of stomach and duodenum.

Extrinsic compressions of stomach or duodenum (ECSD) are occasionally found during endoscopic examination. Ultrasonography is usually performed in order to explain the significance of this feature. We have prospectively assessed the prevalence of ECSD and the diagnostic role of US in this context. ECSD were found in 37 out of 6604 gastroduodenoscopies. An abdominal US was performed after endoscopy in all these patients. The extrinsic compressions were in the gastric anterior wall in 7 patients in the gastric posterior wall in 10 patients, and in the lesser curvature in 9 patients and in the duodenum in 11 patients. In 20 patients the compression was due to neoplastic lesions, in another 15 non neoplastic conditions were found (hepatomegaly, splenomegaly, gallbladder hydrops, pancreatic pseudocyst, vascular malformations). Ultrasonography was demonstrated to have an elevated sensitivity (87.5%) and an elevated specificity (100%) when technically adequate. We conclude that extrinsic compressions of stomach and duodenum detected at endoscopy are frequently associated to neoplastic lesions. Abdominal ultrasonography is an accurate tool, when technically adequate, as an initial screening test for such lesions. Endosonography, CT scan or other invasive tests must be performed in doubtful cases.

Predictive value of ultrasonography in the screening of non-ascitic cirrhotic patients with large varices.

To evaluate the accuracy of ultrasonography in the screening of cirrhotic patients with large varices, the receiver operator characteristic (ROC) curves of the portal, mesenteric, and splenic veins of 215 consecutive non-ascitic patients were plotted in order to select the most indicative optimal threshold. The contribution of respiratory variations of splenic and mesenteric veins was also evaluated. Taking 13 mm as the limit for the normal diameter of the portal vein, 10 and 9 mm for the upper limits of the mesenteric and splenic veins, respectively, and respiratory variations being absent, the positive rates were 91, 88, and 92 per cent and the false-positive rates were 44, 38, and 42 per cent, respectively. The predictive values of a positive test were 0.34, 0.33, and 0.34, respectively, and the predictive values of a negative test were 0.96 for the portal and mesenteric veins and 0.97 for the splenic vein. Because the portal vein is always visible, the portal diameter may be employed in the screening through the presence of large varices in association with the assessment of respiratory variation in the splenic or mesenteric diameter. A cut-off point of 13 mm and the absence of respiratory variations precludes the need for endoscopy in 47 per cent of patients.

Endoscopic retrograde cholangiography in hepatic hydatid disease.

Endoscopic retrograde cholangiography provides safe preoperative documentation of the relationship of hepatic hydatid cysts to the biliary ductal system and accurate distinction from coincident calculus disease.