Prevalence of inflammatory bowel disease among patients with primary sclerosing cholangitis in Iran.

BACKGROUND AND STUDY AIMS: In Iran, the epidemiology of primary sclerosing cholangitis (PSC) and its association with inflammatory bowel disease (IBD) have not been studied thoroughly. This study investigates the epidemiology and prevalence of IBD among patients with PSC. PATIENTS AND METHODS: A retrospective study of 154 patients with PSC was conducted. The demographic and clinical data were collected, and the variables were analysed in the following two patient groups: patients with both PSC and IBD, and patients with PSC and without IBD. RESULTS: A total of 154 patients with a mean age of 40.3years (range 20-81years) were included, of whom 57 (37%) were female and 97 (63%) male. Ninety-six patients (62.3%) were diagnosed with IBD, 92 (59.7%) with ulcerative colitis, and four (2.6%) with Crohn's disease. In this study, elevated alkaline phosphatase levels were found in 90.8% of patients. The intra-hepatic duct (IHD) and extrahepatic duct (EHD) were involved in 70.5% of patients, isolated intrahepatic bile duct in 24.4%, and isolated extrahepatic duct in 3.8%. Small-duct PSC (normal results of imaging and PSC proved by histology of liver biopsy) was observed only in 1.3% of patients. CONCLUSION: PSC has become increasingly diagnosed in Iran. This is possibly because of better diagnostics and the increasing prevalence of IBD in this country. For diagnosing PSC and identifying the presence of IHD strictures, the results of both magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) showed good interobserver agreement, but the ERCP results could be used to evaluate the presence and severity of EHD strictures.

Diagnostic potency of EUS-guided FNA for the evaluation of pancreatic mass lesions.

BACKGROUND AND OBJECTIVES: Diagnosis of pancreatic lesions remains a clinical challenge. This study aimed to evaluate the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in pancreatic mass lesions. PATIENTS AND METHODS: Clinical data, laboratory tests, and cytopathological and imaging reports were collected from 185 pancreatic EUS cases performed from March 2010 to January 2014. The final diagnosis was based on surgical findings, EUS-FNA or computed tomography (CT)-guided biopsy. RESULTS: A total of 100 pancreatic FNAs were obtained by EUS. Most positive diagnoses of malignancy were pancreatic adenocarcinomas (n = 61). The site of pancreatic adenocarcinoma was the head in 50 (82.0%), body in seven (11.5%), and tail in four (6.5%). The sensitivity, specifi city, and positive and negative predictive values of EUS-FNA for diagnosing adenocarcinoma were 80.3%, 92.3%, 94.2%, and 75.0%, respectively. DISCUSSION: We concluded that EUS-FNA of pancreatic lesion accurately diagnoses pancreatic adenocarcinoma and should be considered for the standard management of pancreatic adenocarcinoma.

Comparison of two techniques for endoscopic ultrasonography fine-needle aspiration in solid pancreatic mass.

BACKGROUND: Endoscopic ultrasonography (EUS) is a newly imagine procedure for assessment and therapeutic in option. The aims of this study are comparison two techniques about EUS-fine-needle aspiration (EUS-FNA), including successful tissue sampling, complication, procedure time, and safety. MATERIALS AND METHODS: A total of 100 patients with pancreatic solid masses were in the study, 50 patients underwent EUS-FNA with negative pressure as Group 1 and 50 patients underwent EUS-FNA without negative pressure and stylet as Group 2 over a 36 months period. RESULTS: The study period was from March 2011 to January 2014. In total case, the male-to-female ratio was 1.27 with a mean age of 61.7 ± 1.3 years. The involvement of different regions of the pancreas, pancreatic head had the most frequent (69%) after that uncinate (12%), body (11%) and tail (8%). In 100 pancreatic EUS-FNA samples, 48% were interpreted as malignant on pathology evaluation, 15% as suspicious for malignancy, 27% as benign processes and 10% inadequate specimen. There were no significant differences between the adequacy of sample cells in two techniques (P < 0.148). CONCLUSION: The EUS-FNA without negative pressure and stylet technique was related with less contamination by blood and raise the diagnostic yield. We recommend further studies for better evaluation of our study with higher the cases because clinically the low the inadequate samples (6% vs. 14%) and less contamination with blood (20% vs. 50%) in the second group (P < 0.002).

Clinical, laboratory biomarkers and imaging findings of pancreatic adenocarcinoma in Iran.

BACKGROUND: Pancreatic cancer has a high mortality rate because it is usually diagnosed late. Since little is known about this cancer in Iran, with the aim of improving this knowledge deficiency, we evaluated clinical, laboratory biomarkers, imaging findings and treatment modalities in Iranian patients with pancreatic adenocarcinoma. MATERIALS AND METHODS: 131 cases of pancreatic adenocarcinoma in 2010-2013 were obtained from the Taleghani Hospital Record Department. Cases confirmed by histopathology from CT-guided biopsy, EUS-FNA and surgery examination were included. We excluded those with incomplete medical records. RESULTS: The study included 131 subjects between 24 and 97 years of age and a mean age of 63 ± 13.4 years. Eighty (61.1%) were male and 51 (38.9%) female. Previous history included diabetes mellitus in 36 (27.5%), alcohol drinking in 5 (3.9%), smoker in 28 (21.4%) and opium addiction in 13 (10%) . The common presenting history included weight loss in 79 (60.3%), abdominal pain in 77 (58.8%), fever in 11 (8.4%), nausea in 30 (22.9%), jaundice in 72 (55%), pruritus in 52 (39.7) and anemia in 33 (25.2%) . CA19-9 levels with cut offs of 50, 100 and 200 U/ml were increased in 81%, 72% and 66% of patients, respectively. Tumor staging was: stage I, 3 (2.3%); stage II, 10 (7.6%); stage III, 58 (44.3%); and stage IV, 60 (45.8%). From 45 patients, 17 received ERCP inserted metallic stents and 22 plastic stents, the remaining 6 failed that PTC was done. Whipple surgery and chemotherapy were conducted for 10 and 29 patients, respectively. CONCLUSIONS: This disease affected older people and there was a male preponderance. The commonest risk factors were diabetes mellitus, smoking and cholelithiasis. The majority of patients presented with loss of appetite, loss of weight, jaundice, abdominal pain and discomfort. Almost all presented at late stages of the disease so that curative surgery was impossible. Also chemotherapy was only performed in a few patients as a neoadjuant treatment.