An evidence-based consensus statement on the role and application of endosonography in clinical practice.

BACKGROUND: Endoscopic ultrasonography (EUS) has evolved over the past 20 years with the emergence of novel diagnostic and therapeutic indications. Our goal was to identify the best evidence supporting the use of EUS. MATERIALS AND METHODS: A six-step approach was employed to develop recommendations using accepted methodology. Twenty-two experienced endosonographers identified topics and reviewed studies using MeSH (medical subject headings) terminology and free text in PubMed. Medline and society abstracts were reviewed if necessary. The quality of evidence, the strength of recommendations, and level of consensus were graded and voted on. RESULTS: Consensus was reached for several clinical scenarios for which the impact of EUS findings was supported by a high level of evidence. These included diagnosis and staging of esophageal cancer, differential diagnosis of subepithelial lesions, thickened gastric folds, assessment of peritoneal involvement in patients with gastric cancer, mucosa-associated lymphoid tissue lymphoma, diagnosis of common bile duct/gallbladder stones, diagnosis of chronic pancreatitis, differential diagnosis of a solid mass in patients with chronic pancreatitis, differential diagnosis of pancreatic cyst, rectal cancer staging, and diagnosis and staging of non-small-cell lung cancer. The recommendations were adopted by the Brazilian Society of Gastrointestinal Endoscopy. Several indications continue to emerge and require additional validation.

[Contribution of hepatic immunoglobulin A deposits to the diagnosis of alcoholic hepatopathy]. / Contribuição dos depósitos hepáticos de imunoglobulina a no diagnóstico da hepatopatia alcoólica.

BACKGROUND: Alcoholic hepatic disease is a severe and frequent disease and its diagnosis is not always an easy task. AIM: To assess the contribution of immunoglobulin A (IgA) in the hepatic sinusoids for diagnosis of alcoholic hepatopathy. PATIENTS AND METHODS: The presence of IgA was studied through direct immunofluorescence in 59 patients submitted to hepatic needle biopsy, indicated by clinical or in vitro changes suggestive of chronic hepatopathy. RESULTS: A significant deposition of IgA was found in alcoholic patients as compared to non-alcoholic patients, with 76% sensitivity (95% CI: 54.5-89.8) and 73.5% specificity (95% CI: 55.3-86.5). In individuals who present only alcohol as the etiological agent of hepatopathy, compared with the subgroup of B or C virus carriers, the results were even more significant, with 85.7% sensitivity (95% CI: 56.2-97.5) and 89.5% specificity (95% CI: 65.5-98.2). CONCLUSION: The deposition of IgA in the hepatic sinusoids present sensitivity and specificity for the diagnosis of an alcohol-induced hepatic lesion. This resource can be particularly useful when conventional histology can not be define a specific cause for the change found.