scholarly journals Case Report: Painless obstructive jaundice caused by IgG4 autoimmune pancreatitis; the role of endoscopic ultrasound in diagnosis

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1344
Author(s):  
Sofia Voidila ◽  
Panagiotis Sideris ◽  
Constantinos Letsas ◽  
Elias Anastasopoulos ◽  
Ioanna Oikonomou
Keyword(s):  
Magnetic Resonance ◽  
Obstructive Jaundice ◽  
Diagnostic Criteria ◽  
Endoscopic Ultrasound ◽  
Autoimmune Pancreatitis ◽  
Correct Diagnosis ◽  
Final Diagnosis ◽  
Unknown Etiology ◽  
Type I

We report the case of a 60-year-old woman, presenting with painless obstructive jaundice of unknown etiology, who was finally found to suffer from type I autoimmune pancreatitis (AIP). This case emphasizes AIP as a rare cause in the differential diagnosis of obstructive jaundice and the role of endoscopic ultrasound (EUS) in final diagnosis, which is difficult to establish. According to diagnostic criteria, we combined the results from serologic, imaging and histological features (specifically lgG4 levels, computed tomography, magnetic resonance imaging/magnetic resonance cholangiopancreatography and EUS) with cytological results, leading to a final diagnosis. Our patient’s response to corticosteroids was impressive, confirming the diagnosis, leading to complete remission of the disease. Whilst diagnosis of AIP is challenging, the application of diagnostic criteria can lead to correct diagnosis. Therapy is corticosteroid based, with very satisfying outcomes.

scholarly journals Role of Ultrasound as Compared with ERCP in Patient With Obstructive Jaundice

2015 ◽  
Vol 11 (3) ◽  
pp. 237-240 ◽  
Author(s):  
S Karki ◽  
KS Joshi ◽  
S Regmi ◽  
RB Gurung ◽  
B Malla
Keyword(s):  
Magnetic Resonance ◽  
Obstructive Jaundice ◽  
Imaging Modality ◽  
Final Diagnosis ◽  
Endoscopic Retrograde Cholangiography ◽  
University Hospital ◽  
Endoscopic Retrograde ◽  
Non Invasive ◽  
Imaging Tool

Background The diagnosis of obstructive jaundice relies on proper history taking, clinical examination, laboratory investigations and different non invasive imaging modalities like Ultrasonography (USG), Cholangio Computed Tomography (CCT), Magnetic resonance Imaging (MRI) with Magnetic Resonance Cholangio Pancreatography (MRCP) and invasive modalities like endoscopic retrograde cholangiography (ERCP) and percutaneous trans hepatic cholangiography (PTC). Objective To compare the role of ultrasound with endoscopic retrograde cholangiography and to determine the major causes of obstructive jaundice in our prospect. Methods This was a prospective, analytical study conducted on 88 patients presenting to Department of Radiodiagnosis and Imaging at Dhulikhel Hospital-Kathmandu University hospital from March 2011 to August 2012 with clinical diagnosis of obstructive jaundice. Sonographic evaluation was performed in Siemens acusion x-150 and x-300. The final diagnosis was made by endoscopic retrograde cholangiography and /or surgery and confirmed histopathologically. Results The most common benign causes of obstructive jaundice were choledocholithiasis (63%), CBD stricture (12.3%), cholangitis (8%) and pancreatitis (6.85%) whereas cholangio carcinoma (6.85%) and carcinoma head of pancreas (4%) comprised of the malignant causes . Ultrasonography had sensitivity of 100% and specificity of 89% in detecting choledocholithiasis. It was found to be 98.78% sensitive and 83.33% specific in cholangiocarcinoma. Similarly in pancreatitis, the sensitivity of ultrasonography was 97.59% and sensitivity was 66.67%. Conclusion Ultrasonography acts as a valuable diagnostic imaging modality in detecting the causes of obstructive jaundice. Due to its easy availability, non invasive nature and cost effectiveness, it can be considered as the first line imaging technique/ tool. ERCP is the invasive imaging tool and can be used for both diagnostic and therapeutic purpose. DOI: http://dx.doi.org/10.3126/kumj.v11i3.12512 Kathmandu Univ Med J 2013; 43(3):237-240

Usefulness of endoscopic ultrasound-guided fine-needle biopsy for the diagnosis of autoimmune pancreatitis using a 22-gauge Franseen needle: a prospective multicenter study

Endoscopy ◽  
2020 ◽  
Vol 52 (11) ◽  
pp. 978-985 ◽  
Author(s):  
Takuya Ishikawa ◽  
Hiroki Kawashima ◽  
Eizaburo Ohno ◽  
Hiroki Suhara ◽  
Daijuro Hayashi ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Endoscopic Ultrasound ◽  
Autoimmune Pancreatitis ◽  
Needle Biopsy ◽  
Fine Needle Biopsy ◽  
Histological Evaluation ◽  
Ultrasound Guided ◽  
Detection Rates ◽  
Fine Needle ◽  
Level 1

Abstract Background Detailed histological evaluation is important in the diagnosis of autoimmune pancreatitis (AIP). However, it remains challenging to obtain adequate tissue from the pancreas. Recently, several reports have suggested the usefulness of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) using the new “core” needles for acquiring pancreatic tissue. We aimed to investigate the usefulness of EUS-FNB for diagnosing AIP with one such needle, a 22-gauge Franseen needle. Methods Patients who met the imaging diagnostic criteria for AIP based on the International Consensus Diagnostic Criteria (ICDC) were enrolled in the study. All patients underwent EUS-FNB with a 22-gauge Franseen needle. Histological findings were evaluated based on the ICDC, and the detection rates of level 1 and level 1 or 2 histology were calculated. Results 56 patients from 11 different institutions were enrolled in the final analysis (55 suspected to have type 1 AIP and one with type 2 AIP). Lymphoplasmacytic infiltration, obliterative phlebitis, storiform fibrosis, and > 10 IgG4-positive cells per high-power field were detected in 55 (100 %), 24 (43.6 %), 40 (72.7 %), and 36 (65.5 %) of the 55 patients, respectively. The detection rates of level 1 and level 1 or 2 histology for AIP were 58.2 % (95 % confidence interval [CI] 44.1 % – 71.3 %) and 92.7 % (95 %CI 82.4 % – 98.0 %), respectively, which were apparently higher than our historical results (7.9 % [95 %CI 1.7 % – 21.4 %] and 62.2 % [95 %CI 46.5 % – 76.2 %], respectively) using a conventional needle. Conclusions EUS-FNB with a 22-gauge Franseen needle demonstrated favorable detection rates which would be clinically beneficial for the histological diagnosis of AIP.

94 Role of Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA) in the Evaluation of Intra-Abdominal Lymphadenopathy of Unknown Etiology

2012 ◽  
Vol 142 (5) ◽  
pp. S-23 ◽  
Author(s):  
Nonthalee Pausawasdi ◽  
Phunchai Charatcharoenwitthaya ◽  
Tassanee Sriprayoon ◽  
Varayu Prachayakul ◽  
Supot Pongprasobchai ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Unknown Etiology ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
Abdominal Lymphadenopathy

scholarly journals The role of percutaneous transhepatic biliary biopsy in the diagnosis of patients with obstructive jaundice: an initial experience

2019 ◽  
Vol 52 (4) ◽  
pp. 222-228 ◽  
Author(s):  
Tiago Kojun Tibana ◽  
Renata Motta Grubert ◽  
Vinicius Adami Vayego Fornazari ◽  
Fábio Colagrossi Paes Barbosa ◽  
Bernardo Bacelar ◽  
...  
Keyword(s):  
Obstructive Jaundice ◽  
False Negative ◽  
Final Diagnosis ◽  
High Rate ◽  
Pathology Report ◽  
Bile Duct Stenosis ◽  
Materials Used ◽  
Biliary Biopsy ◽  
Duct Stenosis

Abstract Objective: To evaluate the accuracy of percutaneous transhepatic biliary biopsy (PTBB) in patients with suspected biliary obstruction. Materials and methods: This was a retrospective analysis of 18 patients with obstructive jaundice who underwent PTBB. In each patient, three to ten fragments were collected from the lesion. The final diagnosis was confirmed in the pathology report. We also reviewed analyses of the results of laboratory tests performed before the procedure, as well as the Bismuth classification, clinical outcome, complications occurring during the procedure, access route, and materials used. Results: Technical success was achieved in 100% of the PTBB procedures. Among the 18 patients clinically diagnosed with bile duct stenosis, the pathological analysis confirmed that diagnosis in 17. In one case, the pathological findings were considered false-negative. The predominant tumor was cholangiocarcinoma (seen in 50% of the cases). Sixteen of the procedures (88.9%) were performed without complications. Transient hemobilia occurred in one case, and cholangitis occurred in another. Conclusion: PTBB is a safe, viable, simple technique with a high rate of true-positive results for the definitive diagnosis of obstructive jaundice.

scholarly journals Pancreatico-biliary pathologies: correlation of USG and MRCP

2019 ◽  
Vol 6 (7) ◽  
pp. 2373
Author(s):  
Priyanka Ashok Khopde ◽  
Abhimanyu Kelkar ◽  
Priscilla Joshi ◽  
Amol Bandgar ◽  
Mangal Mahajan
Keyword(s):  
Obstructive Jaundice ◽  
Imaging Modality ◽  
Correct Diagnosis ◽  
Age Groups ◽  
Biliary Disease ◽  
Age Group ◽  
Frequent Form ◽  
Ultrasound Study ◽  
Benign Pathology

Background: Obstructive jaundice is the most frequent form of hepato-biliary pathologies. The main aim is to confirm the presence of obstruction and to identify its cause, location and extent of the lesion. This study evaluated the role of USG and MRCP in hepato-biliary pathology.Methods: Twenty-five patients of all age groups with suspicion of obstructive jaundice referred for Ultrasound were included in our study. The patients with findings suggestive of biliary obstruction underwent MRCP.Results: Out of 25 patients, maximum patients were in the age group of 61-80 yrs. 52% were male and 48% were female. The jaundice was due to a benign etiology in 64% patients and malignant etiology in 36%. The most common benign pathology was choledocholithiasis (25%) and malignant pathology was periampullary carcinoma (44%). Overall 11 cases were inconclusive on ultrasound study while 2 cases were false positive for malignancy on MRCP. In 92% cases the correct diagnosis was detected on MRCP.Conclusions: USG is the initial and sometimes the only imaging modality in obstructive biliary disease. However the distal CBD which is poorly seen on USG can be well evaluated on MRCP thus improving the diagnosis in pancreatico-biliary pathologies.

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