ABSTRACT
Background: Integration of transcriptomic testing into EUS-FNA samples is a growing need for precision oncology in pancreatic ductal adenocarcinoma (PDAC). The NanoString platform is suitable for transcriptome profiling in low yield RNA samples. Methods: Inclusion of patients that underwent EUS-FNA cytological diagnosis of pancreatic ductal adenocarcinoma using 19G and/or 22G needles and subsequent surgical resection. Formalin-fixed, paraffin-embedded (FFPE) cytological and surgical samples underwent RNA extraction and transcriptomic analysis using a custom 52-gene NanoString panel of stromal PDAC features. Cell type abundance was quantified in FFPE specimens and correlated. Results: 18 PDAC patients were included. Mean EUS-FNA passes was 2 + 0.7. All FFPE passed the RNA quality control for genomic analysis. Hierarchical clustering on the global gene expression data showed that genes were differentially expressed between EUS and surgical samples. A more enriched cancer-associated fibroblasts and epithelial-mesenchymal transition transcriptomic profile was observed across surgical specimens whereas immunological biomarkers were more represented in EUS-FNA samples. Cytological examination confirmed a scanty representation of CAF and more immunological cell abundance in cytological samples in comparison to surgical specimens. Conclusion: Targeted transcriptomic NanoString profiling of PDAC samples obtained by EUS-FNA is a feasible approach for pre-surgical molecular analysis although stromal CAF/EMT mRNA biomarkers are underrepresented.
ABSTRACT
OBJETIVO: Evaluar la eficacia y seguridad de la terapia de vacío endoscópica (TVE) en perforaciones y dehiscencias del tracto digestivo superior. PACIENTES Y MÉTODOS: Estudio retrospectivo observacional donde se incluyeron todos los pacientes que presentaron algún defecto del tracto gastrointestinal superior y que fueron sometidos a TVE en el período comprendido entre abril de 2017 y febrero de 2019 en 3 centros españoles. Para ello se utilizó el único sistema de terapia de vacío aprobado para uso endoscópico hasta la fecha (Eso-SPONGEr; B. Braun Melsungen AG, Melsungen, Alemania). RESULTADOS: Un total de 11 pacientes fueron sometidos a TVE como tratamiento de una dehiscencia de sutura anastomótica tras esofaguectomía (n=7), gastrectomía (n=2), como tratamiento de una perforación esofágica tras septomiotomía endoscópica de Zenker (n=1) y tras una perforación esofágica espontánea o síndrome de Boerhaave (n=1). La mediana del tamaño de la cavidad fue de 8×3cm. De mediana, la TVE se inició a los 7días de la cirugía inicial. La mediana de duración de la TVE fue de 28días. La mediana de esponjas colocadas fue de 7 y el intervalo de recambio de las esponjas, de 3,7días. En 10 casos (91%) se consiguió el cierre del defecto y en 9 casos (82%) la resolución clínica del cuadro infeccioso asociado. Cinco pacientes presentaron algún evento adverso: 3 estenosis anastomóticas, un episodio de dolor retrofaríngeo y un caso de neumonía de nueva aparición. La mediana de estancia hospitalaria desde el inicio de la TVE fue de 45días. Un paciente falleció debido a complicaciones sépticas secundarias a la dehiscencia de sutura. CONCLUSIÓN: La TVE tiene una eficacia superior al 90% en las perforaciones y fugas anastomóticas del tracto digestivo superior. Adicionalmente es una terapia segura, siendo los eventos adversos leves
AIM: To evaluate the efficacy and safety of endoscopic vacuum therapy (EVT) in the management of perforations and anastomotic leaks of the upper gastrointestinal tract. PATIENTS AND METHODS: This is a retrospective observational study which included patients who underwent EVT due to any upper gastrointestinal defect between April 2017 and February 2019 in three Spanish Hospitals. To this end, we used the only medical device approved to date for endoscopic use (Eso-SPONGEr; B. Braun Melsungen AG, Melsungen, Germany). RESULTS: 11 patients were referred for EVT of an anastomotic leak after esophagectomy (n=7), gastrectomy (n=2), esophageal perforation secondary to endoscopic Zenker's septomiotomy (n=1) and Boerhaave syndrome (n=1). The median size of the cavity was 8×3cm. The median delay between surgery and EVT was 7 days. The median of EVT duration was 28 days. The median number of sponges used was 7 and the mean period replacement was 3.7 days. In 10 cases (91%), the defect was successfully closed. In 9 cases (82%) clinical resolution of the septic condition was achieved. 5 patients presented some adverse event: 3 anastomotic strictures, 1 retropharyngeal pain and 1 case of new-onset pneumonia. The median hospital stay from the start of EVT was 45 days. 1 patient died owing to septic complications secondary to the anastomotic leak. CONCLUSION: EVT was successful in over 90% of perforations and anastomotic leaks of the upper gastrointestinal tract. Moreover, this is a safe therapy with only mild adverse events associated
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Surgical Wound Dehiscence/therapy , Endoscopy, Digestive System/methods , Treatment Outcome , Intestinal Perforation/surgery , Retrospective Studies , Intestinal Perforation/diagnosis , Digestive System Fistula/surgery , Anastomotic LeakABSTRACT
AIM: To evaluate the efficacy and safety of endoscopic vacuum therapy (EVT) in the management of perforations and anastomotic leaks of the upper gastrointestinal tract. PATIENTS AND METHODS: This is a retrospective observational study which included patients who underwent EVT due to any upper gastrointestinal defect between April 2017 and February 2019 in three Spanish Hospitals. To this end, we used the only medical device approved to date for endoscopic use (Eso-SPONGEr; B. Braun Melsungen AG, Melsungen, Germany). RESULTS: 11 patients were referred for EVT of an anastomotic leak after esophagectomy (n=7), gastrectomy (n=2), esophageal perforation secondary to endoscopic Zenker's septomiotomy (n=1) and Boerhaave syndrome (n=1). The median size of the cavity was 8×3cm. The median delay between surgery and EVT was 7 days. The median of EVT duration was 28 days. The median number of sponges used was 7 and the mean period replacement was 3.7 days. In 10 cases (91%), the defect was successfully closed. In 9 cases (82%) clinical resolution of the septic condition was achieved. 5 patients presented some adverse event: 3 anastomotic strictures, 1 retropharyngeal pain and 1 case of new-onset pneumonia. The median hospital stay from the start of EVT was 45 days. 1 patient died owing to septic complications secondary to the anastomotic leak. CONCLUSION: EVT was successful in over 90% of perforations and anastomotic leaks of the upper gastrointestinal tract. Moreover, this is a safe therapy with only mild adverse events associated.
Subject(s)
Anastomotic Leak/surgery , Duodenal Diseases/surgery , Endoscopy, Gastrointestinal , Esophageal Perforation/surgery , Intestinal Perforation/surgery , Negative-Pressure Wound Therapy/methods , Stomach Rupture/surgery , Upper Gastrointestinal Tract/surgery , Aged , Female , Humans , Male , Middle Aged , Negative-Pressure Wound Therapy/adverse effects , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: The quality of colon cleansing and the tolerability of anterograde preparation are essential to the success of colorectal cancer screening. AIM: To compare the tolerability and efficacy of low-volume preparations vs the standard regimen in individuals scheduled for an early morning colonoscopy. Study: Participants in a population-based colorectal cancer screening program using the fecal immunochemical test who were scheduled for a colonoscopy from 09:00 a.m. to 10:20 a.m. were prospectively included and assigned to: (1) control group (PEG-ELS 4L): PEG 4L and electrolytes; (2) group AscPEG-2L: a combination of PEG and ascorbic acid 2L; and (3) group PiMg: sodium picosulfate and magnesium citrate 500 mL plus 2 L of clear fluids. Tolerability was evaluated with a questionnaire and the quality of bowel preparation with the Boston Bowel Preparation Scale. RESULTS: A total of 292 participants were included: 98 in the PEG-ELS 4L control group, 96 in the AscPEG-2L study group and 98 in the PiMg study group. Low-volume treatments were better tolerated than the standard solution (AscPEG-2L 94.8% and PiMg 93.9% vs PEG-ELS 4L 75.5%; p < 0.0001). The effectiveness of AscPEG-2L was superior to that of PEG-ELS 4L and PiMg (p = 0.011 and p = 0.032, respectively). Patient acceptance was higher for single-dose than for split-dose administration but efficacy was higher with the split dose than with other doses. CONCLUSIONS: In early morning colonoscopies, ascPEG-2L appears to be the best option, especially when administered in a split-dose
ANTECEDENTES: La calidad de la limpieza del colon y la tolerancia a la preparación anterógrada son claves para el éxito de un programa de cribado de cáncer colorrectal. OBJETIVO: Comparar la tolerancia y eficacia de las preparaciones de volumen reducido frente a la preparación estándar en pacientes programados para colonoscopia a primera hora de la mañana. Estudio: Individuos del programa de cribado poblacional con test de sangre oculta en heces programados para colonoscopia entre las 09:00 y 10:20 a.m fueron prospectivamente asignados a: 1) Grupo Control (PEG-ELS 4L): PEG con electrolitos 4 litros; 2) Grupo AscPEG-2L: PEG más ácido ascórbico 2 litros; y 3) Groupo PiMg: picosulfato sódico más citrato de magnesio 500 ml seguido de 2 litros de líquidos claros. Se evaluó la tolerancia mediante cuestionario y la calidad mediante la Boston Bowel Preparation Scale. RESULTADOS: Se incluyeron 292 sujetos: 98 en el grupo control PEG-ELS 4L, 96 en el grupo a estudio AscPEG-2L y 98 en el grupo a estudio PiMg. Las soluciones de volumen reducido fueron mejor toleradas que la solución estándar (AscPEG-2L 94.8% y PiMg 93.9% vs PEG-ELS 4L 75.5%; p < 0.0001). La calidad de la preparación fue superior en el grupo AscPEG-2L que en el grupo control PEG-ELS 4L y grupo PiMg (p = 0.011 and p = 0.032, respectivamente). Las dosis partidas fueron peor aceptadas por los sujetos pero resultaron en una mayor calidad de la preparación. CONCLUSIONES: AscPEG-2L es la mejor opción para las colonoscopias programadas a primera hora de la mañana, especialmente cuando se administra en dosis partida
Subject(s)
Humans , Colonoscopy/methods , Ascorbic Acid/administration & dosage , Colorectal Neoplasms/diagnosis , Preoperative Care/methods , Early Detection of Cancer/methods , Drug ToleranceABSTRACT
BACKGROUND: The quality of colon cleansing and the tolerability of anterograde preparation are essential to the success of colorectal cancer screening. AIM: To compare the tolerability and efficacy of low-volume preparations vs the standard regimen in individuals scheduled for an early morning colonoscopy. STUDY: Participants in a population-based colorectal cancer screening program using the fecal immunochemical test who were scheduled for a colonoscopy from 09:00 a.m. to 10:20 a.m. were prospectively included and assigned to: (1) control group (PEG-ELS 4L): PEG 4L and electrolytes; (2) group AscPEG-2L: a combination of PEG and ascorbic acid 2L; and (3) group PiMg: sodium picosulfate and magnesium citrate 500 mL plus 2L of clear fluids. Tolerability was evaluated with a questionnaire and the quality of bowel preparation with the Boston Bowel Preparation Scale. RESULTS: A total of 292 participants were included: 98 in the PEG-ELS 4L control group, 96 in the AscPEG-2L study group and 98 in the PiMg study group. Low-volume treatments were better tolerated than the standard solution (AscPEG-2L 94.8% and PiMg 93.9% vs PEG-ELS 4L 75.5%; p < 0.0001). The effectiveness of AscPEG-2L was superior to that of PEG-ELS 4L and PiMg (p = 0.011 and p = 0.032, respectively). Patient acceptance was higher for single-dose than for split-dose administration but efficacy was higher with the split dose than with other doses. CONCLUSIONS: In early morning colonoscopies, ascPEG-2L appears to be the best option, especially when administered in a split-dose.
Subject(s)
Ascorbic Acid/analogs & derivatives , Cathartics/pharmacology , Colonoscopy/methods , Colorectal Neoplasms/diagnosis , Defecation/drug effects , Early Detection of Cancer/methods , Polyethylene Glycols/pharmacology , Aged , Ascorbic Acid/administration & dosage , Ascorbic Acid/adverse effects , Ascorbic Acid/pharmacology , Cathartics/administration & dosage , Cathartics/adverse effects , Citrates/administration & dosage , Citrates/adverse effects , Citrates/pharmacology , Citric Acid/administration & dosage , Citric Acid/adverse effects , Citric Acid/pharmacology , Dizziness/chemically induced , Drug Administration Schedule , Female , Humans , Male , Middle Aged , Nausea/chemically induced , Organometallic Compounds/administration & dosage , Organometallic Compounds/adverse effects , Organometallic Compounds/pharmacology , Pain/chemically induced , Patient Acceptance of Health Care , Picolines/administration & dosage , Picolines/adverse effects , Picolines/pharmacology , Polyethylene Glycols/administration & dosage , Polyethylene Glycols/adverse effects , Prospective Studies , Surveys and Questionnaires , Vomiting/chemically inducedABSTRACT
BACKGROUND AND AIM: The diagnosis of gastrointestinal stromal tumors (GISTs) has important prognostic and therapeutic implications. The specific diagnosis of GIST has to be based on immunocytochemistry. This study aimed to prospectively compare in a crossover manner the accuracy of endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) and EUS-guided trucut biopsy (EUS-TCB) in the specific diagnosis of gastric GISTs. We hypothesized that EUS-TCB is superior to EUS-FNA in this respect. PATIENTS AND METHODS: Forty patients with gastric subepithelial tumors suspected on the basis of EUS of being a GIST underwent both EUS-FNA and EUS-TCB. The sequence in which the techniques were employed was randomly assigned to avoid bias. RESULTS: Forty tumors were sampled (mean number of passes: 2.1 +/- 0.9 with EUS-TNB and 1.9 +/- 0.8 with EUS-FNA; P = not significant, NS). Final diagnoses were: GIST (n = 27), carcinoma (n = 2), leiomyoma (n = 1), schwannoma (n = 1), and no diagnosis possible (n = 9). Device failure occurred in 6 patients with EUS-TCB. A cytohistological diagnosis of mesenchymal tumor (n = 29) and carcinoma (n = 2) was made in 70 % of cases by EUS-FNA and in 60 % of cases by EUS-TCB ( P = NS). Among the samples that were adequate, immunohistochemistry could be performed in 74 % of EUS-FNA samples and in 91 % of EUS-TCB samples ( P = 0.025). When inadequate samples were included, the overall diagnostic accuracy of EUS-FNA was 52 % and that of EUS-TCB was 55 % ( P = NS). There were no complications. CONCLUSIONS: EUS-TCB is not superior to EUS-FNA in GISTs because of the high rate of technical failure of trucut. However, when an adequate sample is obtained with EUS-TCB, immunohistochemical phenotyping is almost always possible. EUS-TCB can be safely performed in this set of patients.
Subject(s)
Biopsy, Needle , Endosonography , Gastrointestinal Stromal Tumors/diagnosis , Stomach Neoplasms/diagnosis , Adult , Aged , Aged, 80 and over , Biopsy, Fine-Needle , Cross-Over Studies , Female , Gastrointestinal Stromal Tumors/pathology , Gastroscopy , Humans , Male , Middle Aged , Prospective Studies , Stomach Neoplasms/pathologyABSTRACT
OBJECTIVES: Self-expanding metal stents (SEMS) are increasingly being used to treat malignant colorectal obstruction. However, complications have been reported in up to 50% of patients. There is limited information on long-term outcomes of these patients. The aim of this study was to retrospectively assess the long-term clinical success of SEMS in patients with malignant colorectal obstruction in a single tertiary center and to identify possible predictive factors of developing complications. METHODS: A total of 47 attempts to insert colorectal SEMS were made in 47 patients during a 5-year period. Stents of 9-cm length were placed under endoscopic and radiologic monitoring. After 24 h, all patients underwent abdominal X-ray to verify correct positioning of the stent. Patients were followed at the outpatient clinic. RESULTS: Insertion success was achieved in 44 (94%) patients. Acceptable initial colonic decompression was observed in 44 out of 47 (94%) attempts and in all (100%) successfully inserted stents. The stents were placed in the rectum (n=7, 15%), sigmoid (n=33, 70%), left colon (n=4, 9%), or anastomosis (n=3, 6%). The majority of patients had stage IV disease (n=40, 85%). SEMS served as a bridge to scheduled surgery in 9 (20%) patients and as a palliative definitive treatment in 38 (80%) cases. Three patients were lost to follow-up, so the outcome was evaluated in 41 patients. Long-term clinical failure occurred in 21 (51%) patients and was due to complications such as: migration (n=9, 22%), obstruction (n=7, 17%), perforation (n=3, 7%), and tenesmus (n=2, 5%). Perforations occurred 3, 4, and 34 days after insertion, and all patients died. In the bridge-to-surgery group, primary anastomosis was possible in only four of nine patients (44%). Clinical failure was not associated with any tumor-related factor. However, eight of nine patients with stent migration and two of three patients with perforation had been previously treated with chemotherapy. CONCLUSIONS: Placement of SEMS does not seem to be as effective as suggested because of late complications. For patients with potentially curable lesions, the use of colonic stents for malignant obstruction should only be considered when surgery is scheduled shortly after the stent insertion. Moreover, in patients with incurable obstructing colorectal cancer eligible for chemotherapy and a long life expectancy, palliative treatments other than SEMS should be considered.
Subject(s)
Colorectal Neoplasms/complications , Intestinal Obstruction/surgery , Palliative Care/methods , Prosthesis Failure , Stents/adverse effects , Adult , Aged , Aged, 80 and over , Cohort Studies , Colonoscopy/adverse effects , Colonoscopy/methods , Colorectal Neoplasms/mortality , Colorectal Neoplasms/pathology , Female , Follow-Up Studies , Humans , Intestinal Obstruction/etiology , Intestinal Obstruction/mortality , Intestinal Obstruction/pathology , Kaplan-Meier Estimate , Male , Metals , Middle Aged , Neoplasm Staging , Postoperative Complications/diagnosis , Postoperative Complications/mortality , Predictive Value of Tests , Probability , Prosthesis Design , Retrospective Studies , Risk Assessment , Statistics, Nonparametric , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND AND STUDY AIM: Acute pancreatitis as a complication of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions is rarely observed. However, there is little information on the incidence of hyperamylasemia after EUS-FNA of the pancreas and its clinical significance. This study aimed to supply this lack of information. PATIENTS AND METHODS: Patients who underwent EUS-FNA of a pancreatic lesion between October 2004 and October 2005 were studied prospectively. Exclusion criteria were: (i) platelet count under 50,000/mm (3) and/or prothrombin time < 50 %; (ii) performance of surgery, endoscopic retrograde cholangiopancreatography (ERCP), a percutaneous biopsy attempt, or another invasive procedure within 7 days before EUS-FNA; (iii) lack of informed consent. Serum amylase levels were determined before and 8 and 24 h after the procedure. Hyperamylasemia was defined by amylase levels above 104 UI/L (and higher than baseline levels) 8 h after the procedure. Acute pancreatitis was defined by upper abdominal pain (with or without nausea and/or vomiting) accompanied by elevation of serum amylase or lipase to at least twice baseline levels. RESULTS: A total of 100 patients underwent EUS-FNA of a pancreatic lesion (58 men, 42 women; mean age 60 +/- 13 years). Eleven patients (11 %) showed hyperamylasemia 8 h after the puncture (298 +/- 293 UI/L, range 105 - 1044 UI/L), but only two of them developed acute mild pancreatitis after EUS-FNA. Hyperamylasemia was not related either to the type of lesion (cystic or solid) or to its location, the duration of the procedure, or the number of passes performed. CONCLUSIONS: Pancreatitis after pancreatic EUS-FNA occurs in 2 % of patients, with some more cases of silent hyperamylasemia. This complication may have to be included in the information given to patients for their informed consent.
