Relationship between patient symptoms and endosonographic findings in chronic pancreatitis.

BACKGROUND/AIMS: The endoscopic ultrasound (EUS) diagnosis of chronic pancreatitis (CP) relies on the presence of up to nine distinct pancreatic parenchymal and ductal abnormalities, without considering other factors such as age, duration of disease or clinical symptoms. Our goal was to examine the impact of patient symptoms on EUS findings in patients with CP. METHODS: All patients with previously suspected CP who had symptomatic disease referred to our medical center for pancreatic EUS were identified. Patients were stratified into two groups based on their clinical symptoms--pain only and steatorrhea +/- pain. Groups were compared using two-tailed comparative testing. RESULTS: 53 patients (group 1) with pain only and 27 patients with steatorrhea +/- pain (group 2) were identified. Patients in group 1 were younger and more likely female. Compared to group 1 (pain only), group 2 (steatorrhea +/- pain) had more total (5.37 vs. 3.28, p < 0.01) and ductal abnormalities (2.56 vs. 0.83, p < 0.01), although the number of parenchymal abnormalities between groups 1 and 2 (2.45 vs. 2.88, p = 0.07) was not different. CONCLUSION: The presence of steatorrhea +/- pain in patients with CP undergoing pancreatic EUS examination is associated with more total and ductal abnormalities. Stratification based on underlying patient symptoms may be valuable as an adjunct to endosonographic findings in making or excluding the diagnosis of CP.

Sublingual hyoscyamine spray as premedication for colonoscopy: a randomized double-blinded placebo-controlled trial.

BACKGROUND: Colonic motility and spasm during colonoscopy may affect duration and quality of the examination as well as patient comfort during and after the procedure. Previous studies assessing the utility of antispasmodic agents in colonoscopy demonstrated conflicting results. The aim of this study was to determine the effect of sublingual hyoscyamine spray (IB-Stat, Inkine Pharmaceutical) on the performance of colonoscopy. METHODS: One hundred patients undergoing elective colonoscopy were randomized in a double-blind study to receive .25 mg sublingual hyoscyamine spray (n = 50: 25 men and 25 women, mean age 60) or placebo spray (n = 50: 23 men and 27 women, mean age 56) 15 to 30 minutes before the procedure. Parameters measured included time required to reach the cecum, total procedure time, endoscopist perception of colonic motility and difficulty of the procedure, and patient assessment of discomfort after the procedure. The latter parameters were measured using a 100-mm visual analog scale. A single endoscopist performed all of the procedures. RESULTS: After adjustment for age, procedural difficulty scores and colonic motility scores were significantly lower in the hyoscyamine group compared with placebo (differences of 5.589 mm [P = .047] and 5.685 mm [P = .040], respectively). Mean time to cecal intubation and percentage of patients with discomfort were slightly lower in the hyoscyamine group (5.68 minutes/48%) compared with placebo (5.92 minutes/57.1%), although the differences were not statistically significant (P = .57 and P = .36, respectively). CONCLUSIONS: Procedural difficulty and colonic motility scores were significantly lower in subjects who received sublingual hyoscyamine before colonoscopy.

Wire-guided pancreatic pseudocyst drainage by using a modified needle knife and therapeutic echoendoscope.

BACKGROUND: Various methods to drain pancreatic pseudocysts by using EUS guidance have been reported in the literature. OBJECTIVE: A new drainage technique is described that uses a modified needle knife advanced over a guidewire positioned in the pseudocyst by EUS guidance. DESIGN: Retrospective chart review. SETTING: Academic medical center. PATIENTS: Consecutive subjects from December 1, 2002, to January 10, 2005, with symptomatic pseudocysts in whom EUS-guided drainage was attempted. INTERVENTIONS: By using a therapeutic linear echoendoscope, a 19-gauge aspiration needle was inserted into the pseudocyst. A guidewire was placed through the needle, and a needle knife with the cutting wire protruding and bent was advanced over the guidewire to contact the stomach mucosa. The needle knife was then advanced by using electrocautery into the pseudocyst. The cystenterostomy was dilated by using a balloon over the guidewire. One to 4 stents were placed through the tract. MAIN OUTCOME MEASUREMENTS: Successful pseudocyst drainage. RESULTS: A total of 21 of 23 patients underwent technically successful pseudocyst drainage. One patient had self-limited hypotension during the procedure. Another patient had free intraperitoneal air after the procedure but correct stent placement. LIMITATIONS: Retrospective analysis, small sample size. CONCLUSIONS: In this preliminary experience, wire-guided pseudocyst drainage with a modified needle knife appears effective and safe while allowing for a more controlled pseudocyst puncture.