Capillary and wet techniques. A pilot study comparing two tissue sampling methods guided by endoscopic ultrasound.

BACKGROUND: There are different techniques for obtaining tissue using a fine needle guided by endoscopic ultrasound (EUS); all aim to obtain the most appropriate material, free of defects, of good quality and in sufficient quantity. OBJECTIVE: The objective of the study was to determine which of the two EUS-guided techniques (capillary and wet) provides better quality samples for cytopathological analysis and which should be used for obtaining tissue from pancreatic, bile duct, liver, and lymph node tumors. MATERIAL AND METHODS: We conducted a pilot prospective study that included 26 patients with evidence of pancreatic tumor, liver tumor, and/or lymph node metastasis of primary tumor. All patients were subjected to two different tissue sampling techniques, the capillary technique and the wet technique, during the same procedure. Both techniques relied on EUS guidance. The samples obtained for the cytopathological analysis were evaluated in blinded manner by two different pathologists. RESULTS: Pathologist A was able to make a diagnosis using the capillary technique in 96.15% of the cases and in 88.46% of the cases using the wet technique. Pathologist B was able to make a diagnosis using the capillary technique in 96.15% of the cases and in 92.30% of the cases using the wet technique. The kappa coefficient between observers for histopathological diagnosis was 1 for capillarity and 0.948 for wet technique. CONCLUSION: The capillary technique yielded better results than the wet technique in terms of sample quality and cellularity.

ANTECEDENTES: Existen diferentes técnicas para la obtención de tejido usando la aguja fina guiada por ultrasonido endoscópico. Todas ellas pretenden obtener el tejido mas apropiado, libre de defectos, con una buena calidad y una cantidad suficiente. OBJETIVO: Determinar cuál de las dos técnicas guiadas por ultrasonido endoscópico (capilar y húmeda) proporciona mejor calidad de la muestra para análisis citopatológico y biopsia de tejido pancreático, vías biliares, hígado y tumores de nodos linfáticos. MÉTODO: Estudio piloto, prospectivo, que incluyó 26 pacientes con evidencia de tumor pancreático, hepático o metástasis de nodos linfáticos. Durante el mismo procedimiento, los pacientes fueron sometidos a las dos técnicas de obtención de muestra tisular guiadas por ultrasonido endoscópico. Las muestras para el análisis citopatológico fueron evaluadas de forma cegada por dos patólogos diferentes. RESULTADOS: El patólogo A pudo hacer el diagnóstico usando la técnica de capilaridad en el 96.15% de los casos y en el 88.46% cuando se usó la técnica húmeda; el patólogo B realizó el diagnóstico en el 96.15% y el 92.30% de los casos, respectivamente. El coeficiente kappa entre los observadores para el diagnóstico histopatológico fue de 1 para la técnica de capilaridad y de 0.948 para la técnica húmeda. CONCLUSIÓN: La técnica de capilaridad mostró mejores resultados en términos de calidad de la muestra y celularidad.

Ampulary tumors: presurgical staging by endoscopic ultrasonography. Diagnostic test study.

OBJECTIVE: To analyze the accuracy of endoscopic ultrasound (EUS) in the evaluation of ampullary tumors compared to histopathology (HP) staging. METHODS: A retrospective diagnostic test study. Patients with ampullary tumors staged by EUS and postpancreatoduodenectomy HP attended during 2012-2018 at tertiary level hospital. RESULTS: 14 patients with adenocarcinoma where included. Tumor size measured by EUS showed an adequate correlation (R = 0.65; p= 0.01) with HP. The accuracy in the evaluation of duodenal wall, pancreatic, and biliary duct invasion was 78.5, 78.5 and 57.1%, respectively. By HP, there were three T1 (21.4%), two T2 (14.2%) and nine T3 (64.2%). The accuracy of T and N staging by EUS was 71.4% (kappa = 0.50) and 50% (kappa = -0.04) respectively. There were more staging errors in patients with biliary stent. CONCLUSION: EUS was useful in estimating tumor size, duodenal wall and pancreatic invasion. Limitation was found in the evaluation of biliary duct invasion, as well as overestimation of T stage and underestimation of N stage. It is necessary an increased effort in ultrasonography training. We suggest EUS testing before biliary stenting.

OBJETIVO: Comparar el ultrasonido endoscópico (USE) en la valoración de los tumores ampulares primarios (TAp) con referencia al estudio histopatológico (HP). MÉTODO: Estudio retrospectivo prolectivo de pruebas diagnósticas en pacientes con TAp estadificados por USE y pancreatoduodenectomía con estudio HP, atendidos de 2012 a 2018 en un hospital de tercer nivel de atención. RESULTADOS: Fueron incluidos14 pacientes con adenocarcinoma. El tamaño del tumor medido por USE mostró una adecuada correlación (R = 0.65; p = 0.01) con el HP. La exactitud en la determinación de la invasión a la pared duodenal, el páncreas y el conducto biliar fue del 78.5, el 78.5 y el 57.1%, respectivamente. Por HP hubo tres T1 (21.4%), dos T2 (14.2%) y nueve T3 (64.2%). La exactitud del estadiaje T y N por USE fue del 71.4% (kappa = 0.50) y del 50% (kappa = −0.04), respectivamente. Los errores en la estadificación fueron más frecuentes en los pacientes con prótesis biliar. CONCLUSIÓN: El USE mostró utilidad en la determinación del tamaño tumoral y de la invasión al duodeno y al páncreas, y más limitada en la determinación de la invasión al conducto biliar por presencia de prótesis. Se observa una sobreestimación del estadiaje T y una subestimación del N. Es necesario mayor capacitación y sugerimos realizarse antes de colocar una prótesis biliar.

[Assessment of amylase and lipase levels following puncture biopsy and fine needle aspiration guided by endoscopic ultrasound in pancreatic lesions]. / Evaluación de los niveles de amilasa y lipasa posterior a la realización de biopsia por aspiración con aguja fina guiada por ultrasonido endoscópico en lesiones del páncreas.

BACKGROUND: Puncture biopsy and fine needle aspiration guided by endoscopic ultrasound has been used as an effective technique and is quickly becoming the procedure of choice for diagnosis and staging in patients suspected of having pancreatic cancer. This procedure has replaced retrograde cholangiopancreatography and brush cytology due to its higher sensitivity for diagnosis, and lower risk of complications. OBJECTIVE: To assess the levels of pancreatic enzymes amylase and lipase, after the puncture biopsy and fine needle aspiration guided by endoscopic ultrasound in pancreatic lesions and the frequency of post-puncture acute pancreatitis. MATERIAL AND METHODS: A longitudinal and descriptive study of consecutive cases was performed on outpatients submitted to puncture biopsy and fine needle aspiration guided by endoscopic ultrasound in pancreatic lesions. Levels of pancreatic enzymes such as amylase and lipase were measured before and after the pancreatic puncture. Finally we documented post-puncture pancreatitis cases. RESULTS: A total of 100 patients who had been diagnosed with solid and cystic lesions were included in the study. Significant elevation was found at twice the reference value for lipase in 5 cases (5%) and for amylase in 2 cases (2%), none had clinical symptoms of acute pancreatitis. Eight (8%) of patients presented with mild nonspecific pain with no enzyme elevation compatible with pancreatitis. CONCLUSION: Pancreatic biopsy needle aspiration guided by endoscopic ultrasound was associated with a low rate of elevated pancreatic enzymes and there were no cases of post-puncture pancreatitis.

[Celiac block in paediatric patients using endoscopic ultrasound for management of severe pain due to chronic pancreatitis. Review of the technique in 2 cases]. / Bloqueo celiaco en Pediatría mediante ultrasonido endoscópico para el manejo de dolor por pancreatitis crónica. Revisión de la técnica en 2 casos.

BACKGROUND: Pancreatic diseases such as cancer, idiopathic recurrent pancreatitis, and chronic pancreatitis, can cause pain that is difficult to control. Pain is one of the most debilitating symptoms and demands increasing doses of analgesics and narcotics, as well as the number of hospital admissions, with a direct implication in the costs of medical treatments. OBJECTIVE: To describe the experience with 2 paediatric patients who were subjected to an ultrasound-guided endoscopic celiac ganglion block for difficult pain management, secondary to chronic pancreatitis disease. CLINICAL CASES: The first case concerns a 9-year-old male with a diagnosis of chronic pancreatitis, and the second case is a 12-year-old female who developed episodes of intermittent acute pancreatitis. Both cases suffered from chronic abdominal pain, which was difficult to control with stronger painkillers, such as opioids. The pain decreased after patients were subjected to an ultrasound-guided endoscopic celiac ganglion block. CONCLUSIONS: This technique showed that both patients obtained satisfactory pain relief, with significant improvements in general symptomatology and the stopping of almost all analgesic medication. The authors suggest that celiac ganglion block must be considered, and implemented early before the usual complications, such as a consumption syndrome that is frequent in paediatric patients with chronic pancreatitis.