Endoscopic ultrasonography shear wave as a predictive factor of endocrine/exocrine dysfunction in chronic pancreatitis

Endoscopic ultrasonography (EUS) is a versatile tool that can be used to perform a variety of diagnostic and therapeutic procedures in the upper or lower gastrointestinal tract. The proximity of the echoendoscope to the pancreas, liver, and other thoracic and abdominal organs allows detailed examination or minimally invasive intervention that would not be feasible by surgical or percutaneous approaches. EUS is available with radial or linear scanning arrays and is capable of guiding fine-needle aspiration to acquire tissue for cytologic analysis. This review covers the role of EUS in chronic pancreatitis; pancreatic cysts; submucosal tumors; suspected choledocholithiasis; fecal incontinence; staging of malignancy in esophageal, pancreatic, gastric, and rectal cancer; celiac plexus block/neurolysis; fiducial placement; pseudocyst drainage and cystogastrostomy/cystoduodenostomy; endoscopic necrosectomy; and biliary drainage. Figures show peripancreatic cysts, gastrointestinal stromal tumor, common bile duct stone, esophageal adenocarcinoma, pancreatic head mass causing biliary obstruction and invading portal confluence, fine-needle aspiration of a pancreatic head mass, rectal adenocarcinoma, abdominal aorta with celiac artery and superior mesenteric artery, celiac plexus neurolysis, necrosectomy, and EUS-guided choledochoduodenostomy for failed endoscopic retrograde cholangiopancreatography. Tables list the Rosemont criteria for chronic pancreatitis and pancreatic cystic lesions. Key words: bile duct stone, biliary drainage, echoendoscope, endoscopic ultrasonography, fine-needle aspiration, pancreatic cyst This review contains 12 highly rendered figures, 2 tables, and 62 references.

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Endoscopic Ultrasonography of the Pancreas as an Indirect Method to Predict Pancreatic Exocrine Insufficiency in Patients With Chronic Pancreatitis

Pancreas ◽

10.1097/mpa.0b013e31823b5978 ◽

2012 ◽

pp. 1 ◽

Cited By ~ 5

Author(s):

J. Enrique Domínguez-Muñoz ◽

Ana Álvarez-Castro ◽

José Lariño-Noia ◽

Laura Nieto ◽

Julio Iglesias-García

Keyword(s):

Chronic Pancreatitis ◽

Endoscopic Ultrasonography ◽

Indirect Method ◽

Pancreatic Exocrine Insufficiency ◽

Exocrine Insufficiency ◽

Pancreatic Exocrine

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Endoscopic ultrasonography is an independent predictive factor of prognosis in locally advanced esophageal cancer. Results from the randomized FFCD 9102 study from the Fédération Francophone de Cancérologie Digestive

Gastroentérologie Clinique et Biologique ◽

10.1016/j.gcb.2007.12.026 ◽

2008 ◽

Vol 32 (3) ◽

pp. 213-220 ◽

Cited By ~ 14

Author(s):

P. Burtin ◽

O. Bouché ◽

M. Giovannini ◽

M. Pelletier ◽

T. Conroy ◽

...

Keyword(s):

Esophageal Cancer ◽

Endoscopic Ultrasonography ◽

Predictive Factor ◽

Locally Advanced ◽

Advanced Esophageal Cancer ◽

Independent Predictive Factor ◽

Cancérologie Digestive ◽

Locally Advanced Esophageal Cancer

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Diagnosis of atypical mass-forming chronic pancreatitis mimicking pancreatic carcinoma: A case report

Journal of Clinical Images and Medical Case Reports ◽

10.52768/2766-7820/1350 ◽

2021 ◽

Vol 2 (5) ◽

Author(s):

Han-Yue Wang ◽

◽

Hao-Su Huang ◽

Meng Wang ◽

Jie Peng ◽

...

Keyword(s):

Computed Tomography ◽

Chronic Pancreatitis ◽

Pancreatic Carcinoma ◽

Endoscopic Ultrasonography ◽

Fine Needle Aspiration ◽

Multimodal Imaging ◽

Needle Aspiration ◽

Imaging Features ◽

Pathological Findings ◽

Fine Needle

Background: Mass-Forming Chronic Pancreatitis (MFCP) is rare. Moreover, atypical MFCP is difficult to differentiate from Pancreatic Carcinoma (PC) in clinical manifestations, laboratory, and imaging examinations. Diagnosis could be supported by the pathological findings of focal inflammatory fibrosis without evidence of tumor in the pancreas. Case summary: A 52-year-old man had acute pancreatitis twice over 7 months. Amylase and lipase levels were three times higher than the normal range without any clinical symptoms. At the 6th month, the patient lost 15 kg of weight, and abdominal ultrasonography revealed pancreatic head space occupied. All the findings in multimodal imaging including computed tomography image, Magnetic Resonance (MR) imaging with MR cholangiopancreatography, and 18F-FDG positron emission tomography/computed tomography showed an irregular nodule with low density, low signal, and low echo in the head of the pancreas, which were lower than those in the normal pancreatic tissue. The proximal main pancreatic duct was truncated and stenosed, and the distal duct was dilated. Subsequently, he developed progressive painless jaundice, and the specific tumor marker levels were increased. Most of these manifestations were suggestive of the pancreatic malignant tumor; however, multiple specimen pathological findings obtained from laparotomy and endoscopic ultrasonography-guided fine-needle aspiration revealed focal chronic inflammation, fibrosis, and necrosis. Conclusion: This report describes a case of atypical MFCP mimicking PC at clinical presentation and laboratory findings, especially in multimodal imaging. However, the combination of atypical multimodal imaging features, which support MFCP rather than PC, and endoscopic ultrasonography-guided fine-needle aspiration are useful for improving the diagnostic rate of atypical MFCP and avoiding unnecessary surgery.

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Los criterios de Rosemont en ultrasonografía endoscópica: ¿son predictores de insuficiencia pancreática exocrina?

Acta gastroenterológica latinoamericana ◽

10.52787/qwpo5827 ◽

2021 ◽

Vol 51 (2) ◽

Author(s):

Marianela Arramón ◽

Agustina Redondo ◽

Pablo Cura ◽

Fernando Baldoni ◽

Ana Brizio ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Endoscopic Ultrasonography ◽

Pancreatic Insufficiency ◽

Descriptive Study ◽

Exocrine Pancreatic Insufficiency ◽

Diagnostic Methods ◽

Fat Quantification ◽

Morphologic Characteristics ◽

Morphologic Changes

Endoscopic ultrasonography is the method of choice for detection of morphologic changes related to chronic pancreatitis. There are criteria, in the literature, that evaluate morphologic changes by endoscopic ultrasonography suggestive of chronic pancreatitis. The most widely used are the Rosemont criteria. Currently, the most effective diagnostic methods for exocrine pancreatic insufficiency are fat quantification (disused) and the 13C-mixed triglyceride breath test, not available in our country. However, the probability of diagnosis of pancreatic insufficiency can be estimated over the base of symptoms, malnutrition parameters, faecal elastase and signs of chronic pancreatitis in images. The aim of this study was to determine the correlation, probability and severity of exocrine pancreatic insufficiency, according to Rosemont criteria, in patients with chronic pancreatitis. A retrospective descriptive study was performed. Data were collected from patients between April of 2017 and April of 2018. The data gathered was based on pancreatic morphologic characteristics according to Rosemont criteria and related to the diagnosis of exocrine pancreatic insufficiency diagnosis based on the levels of stool elastase. Twenty one patients with chronic pancreatitis were included. The presence of hyperechogenic foci > 2 mm with posterior acoustic shadowing was associated with the presence of severe exocrine pancreatic insufficiency (p < 0.001). In our study, the association between parenchymal morphologic findings of chronic pancreatitis was significant in predicting exocrine pancreatic insufficiency. The role of endoscopic ultrasonography in predicting functional compromise in patients with chronic pancreatitis is promising.

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