THE PRIMARY RESEARCH: THE ROLE OF ENDOSCOPIC ULTRASOUND IN DIAGNOSIS OF CHRONIC PANCREATITIS

2017 ◽  
pp. 40-47
Author(s):  
Khanh Vinh ◽  
Van Huy Tran

Background and aims: To evaluate the efficacy of endoscopy ultrasound for diagnosis chronic pancreatitis by Rosemont classification. Patients and methods: A cross - sectional study was conducted on 44 patients undergoing endoscopy ultrasound to diagnose chronic pancreatitis. Results: Study on a total of 44 patients indicated for endoscopic ultrasound. We have some following results: The lesions of chronic pancreatitis on endoscopic ultrasound: The hyperechoic foci without shadowing and stranding was 79.5% and hyperechoic foci with shadowing was 72.7%, cyst and pseudocyst were about 13.6%. Main pancreatic duct dilation is 75%, hyperechoic main pancreatic duct wall was 72.7%, main pancreatic duct stone and irregular main pancreatic duct contour were about 52.2%. Rosemont classification in diagnosis of chronic pancreatitis: Consistent with chronic pancreatitis by 1 major A feature (+) ≥ 3 minor features is 67.5% and 2 major A features is 32.5%. Suggestive of chronic pancreatitis by over 5 minor features is 100%. EUS is more accurate than CT in detecting early chronic pancreatitis. Conclusions: Endoscopic ultrasound is a highly effective method of diagnosing chronic pancreatitis. Key words: endoscopy ultrasound, chronic pancreatitis

2018 ◽  
pp. 20-26
Author(s):  
Van Huy Tran ◽  
Trung Nam Phan ◽  
Khanh Vinh

Background and aims: To evaluate the efficacy of endoscopic ultrasound for diagnosis chronic pancreatitis by Rosemont classification. Patients and methods: A cross – sectional study was conducted on patients undergoing endoscopy ultrasound to diagnose chronic pancreatitis. Results: Study on a total of 57 patients indicated for endoscopic ultrasound. We have some following results: The lesions of chronic pancreatitis on endoscopic ultrasound: The hyperechoic foci without shadowing and stranding is 82.5% and hyperechoic foci with shadowing is 70.2%, cyst and pseudocyst are about 15.8%. Main pancreatic duct dilation is 71.9%, hyperechoic main pancreatic duct wall is 70.2%, main pancreatic duct stone is about 45.6%. Rosemont classification in diagnosis of chronic pancreatitis: Consistent with chronic pancreatitis by 1 major A feature (+) ≥ 3 minor features is 69.4% and 2 major A features is 30,6%. Suggestive of chronic pancreatitis by over 5 minor features is 100%. EUS is more accurate than CT in detecting early chronic pancreatitis. Conclusions:Endoscopic ultrasound is a highly effective method of diagnosing chronic pancreatitis. Key words: chronic pancreatitis, endoscopic ultrasound


Endoscopy ◽  
2020 ◽  
Author(s):  
Calvin Jianyi Koh ◽  
Sundeep Lakhtakia ◽  
Mitsuhiro Kida ◽  
Cosmas Rinaldi A. Lesmana ◽  
Tiing Leong Ang ◽  
...  

Background Although endoscopic ultrasound (EUS) features and criteria have been described in chronic pancreatitis, challenges remain with interoperator variability and ease of adoption. The aim of this study was to define and validate the EUS features of chronic pancreatitis in a multicenter prospective study in Asia. Method The study was divided into two parts: the first part was conducted to derive the EUS features of chronic pancreatitis with adequate interoperator agreement; the second was to prospectively evaluate these features in a multicenter cross-sectional study and determine the optimal combination of features for the diagnosis of chronic pancreatitis. Prospectively enrolled cases had standard internationally validated radiologic or histologic features of chronic pancreatitis, and controls were patients without chronic pancreatitis who underwent EUS examination. Results The top six EUS features that had good interobserver agreement (mean kappa 0.73, range 0.60 – 0.90) were selected to be further evaluated in part II of the study. These included: hyperechoic foci with shadowing, lobularity with honeycombing, cysts, dilated main pancreatic duct, dilated side branches, and calculi in the main pancreatic duct. A total of 284 subjects (132 cases, 152 controls) were enrolled from 12 centers in Asia. All six features had high accuracy ranging from 63.3 % to 89.1 %. Two or more of these six EUS features accurately defined chronic pancreatitis (sensitivity 94.7 %, specificity 98.0 %), with an area under the receiver operating curve of 0.986. Conclusion This multicenter Asian study characterized and defined the EUS features of chronic pancreatitis. This provides a useful tool in clinical practice and further research in pancreatic cancer surveillance.


2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Mazen Shobassy ◽  
Nedaa Husainat ◽  
Abdalaziz Tabash ◽  
Kalpesh Patel ◽  
Hashem B. El-Serag ◽  
...  

Background and Aims. Fecal elastase-1 (FE-1) as a screening test for exocrine pancreatic insufficiency (EPI) is gaining popularity in clinical practice. The role of imaging in patients with FE-1-related suspicion of EPI remains unclear. The aim of this study was to characterize endoscopic ultrasound (EUS) findings for patients with low FE-1. Methods. A retrospective cross-sectional study was performed in 40 patients who had low FE-1 and underwent EUS to evaluate the pancreas. We obtained data on demographic and lifestyle factors, EUS findings, and histopathology results. We compared these variables between patients with FE‐1<100 mcg/g vs. 100-200 mcg/g. Results. Most patients (82.5%) established one or more new diagnoses from EUS. Diagnoses included: definitive chronic pancreatitis (n=29, 72.5%), fatty pancreas (n=9, 22.5%), and pancreatic solid mass or cyst (n=9, 22.5%). Half (n=4) of the solid or cystic lesions were neoplastic. All patients with a solid pancreatic mass also had concurrent chronic pancreatitis. There were no significant differences in EUS findings or demographic or lifestyle factors between groups with FE‐1<100 mcg/g vs. 100-200 mcg/g. Conclusion. Chronic pancreatitis is the most common EUS finding in patients with low FE-1 levels. EUS appears helpful in determining the cause of EPI in most patients with low FE-1 and may detect unsuspected pancreatic neoplasia.


2020 ◽  
Vol 109 (1) ◽  
pp. 69-78 ◽  
Author(s):  
M. Udd ◽  
L. Kylänpää ◽  
A. Kokkola

Chronic pancreatitis is a long-term illness leading to hospital admissions and readmission. This disease is often caused by heavy alcohol consumption and smoking. Patients with chronic pancreatitis suffer from acute or chronic pain episodes, recurrent pancreatitis, and complications, such as pseudocysts, biliary duct strictures, and pancreatic duct fistulas. Pancreatic duct strictures and stones may increase intraductal pressure and cause pain. Endoscopic therapy is aiming at decompressing the pressure and relieving the pain, most commonly with pancreatic duct stents and pancreatic duct stone retrieval. Early surgery is another option to treat the pain. In addition, endotherapy has been successful in treating complications related to chronic pancreatitis. The therapy should be individually chosen in a multidisciplinary meeting. Endoscopic therapy and surgery as treatment options for chronic pancreatitis are discussed in this review.


2019 ◽  
pp. 17-20
Author(s):  
Van Huy Tran ◽  
Thanh Long Nguyen

Background: Diagnosis of gastrointestinal submucosal tumors (SMT) is still a challenge in clinical practice and data about gastrointestinal submucosal tumors in our country was very limited. This study aimed to assess some characteristics of gastrointestinal submucosal tumors. Patients and Methods: cross–sectional study; 195 patients having gastrointestinal submucosal tumors diagnosed by endoscopic ultrasound at Hue University of Medicine and Pharmacy Hospital were enrolled from October 2013 to December 2018. Cutting biopsy or EUS- FNA in case necessary. Results: The mean age of patients was 48.92 ± 15.23. The prevalence was nearly equal in men and women with 48.2% and 51.8%, respectively. According to location, submucosal tumors were 45.6% in the stomach, 35.9% in the esophagus and 2.6% in the colon and rectum. According to etiology, the submucosal cyst was found in 23.6%, the leiomyoma was 22.1%, the Brunner’s gland was 1% and the unknown submucosal tumors was 19.5%. 58.1% of the leiomyoma and 67.4% of the submucosal cyst were found in the esophagus. 76% of the GIST, 83.3% of the ectopic pancreas and 64.7% of the lipoma were found in stomach. Conclusions: Based on endoscopy ultrasound, the most common locations of SMT were stomach and esophagus; the most common SMT were submucosal cyst and leiomyoma. Key words: Submucosal tumor (SMT), Endoscopic ultrasound (EUS)


2019 ◽  
pp. 28-33
Author(s):  
Thi Phuong Nhan Kieu ◽  
Van Huy Tran

Objective: To determine features of endoscopic ultrasound in esophageal cancer and relation with clinic, endoscopy and computerized tomography. Patients and methods: A cross-sectional study was conducted on 40 patients indicated for endoscopic ultrasound to staging esophageal cancer. Results: The total number of patients studied in study were 40. The middle and lower 1/3rd of esophagus affected more commonly compare to other parts. Mean length of tumor in endoscopy was 5.19 ± 2.37cm. The majority of patients presented late with advanced stage of cancer in endoscopy (90%). Squamous cell carcinoma (95%) was the most common histopathological type. CT/TNM staging was documented in 33 (82.5%) patients: T1 (3.1%), T2 (25%), T3 (53.1%), T4a (12.5%), T4b (6.3%), N0 (30.3%). Staging by ultrasonoscopy: Tis (2.5%), T1a (5%), T1b (0), T2 (7.5%), T3 (42.5%), T4a (32.5%), T4b (10%). The predictive value of tumor length was significant in patients with N0 or lympho node status (p = 0.003). Conclusions: Endoscopic ultrasound improved the diagnostic accuracy of esophageal cancer staging. Key words: endoscopic ultrasound, esophageal cance


2019 ◽  
pp. 87-95
Author(s):  
Van Huy Tran ◽  
Khanh Vinh

Background and aims: Data about endoscopic ultrasound in our country was still limited. This study aimed to evaluate the efficacy and safety of endoscopy ultrasound for diagnosis of gastrointestinal and pancreaticobiliary diseases. Patients and methods: A cross - sectional study was conducted on 1176 patients undergoing endoscopy ultrasound to diagnose gastrointestinal- pancreaticobiliary diseases. Results: Study on a total of 1176 patients indicated for endoscopic ultrasound. We have some following results: Gastrointestinal diseases. The submucosal tumor was about 55,74% and gastrointestinal cancer was 44.26%. The local of submucosal tumor: 52.93% with gastric subepithelial lesions, 33.46% oesophageal, 11.67% duodenum and 1.94% from the colorectal. The esophagus cancer was 37.27%, colorectal cancer was 36.27%, gastric cancer was 24.01% and duodenum cancer was 2.45%. Pancreaticobiliary diseases: The common bile duct stone was 68.89%, Biliary tract dilation of unknown cause was 9.64%, vater tumor was 9.42%, cholangioma was 7.89%, billiary diseases was caused by paradise and billiary cyst was 1.97%. Pancreas diseases: 43.25% with chronic pancreatitis, 31.66% pancreas cancer, 17.76% acute pancreatitis and 7.33% pancreas cyst. EUS-FNA for pancreas cancer was about 80% and IPMN was 20%. Complication of hypoxia found in 0.34% and only 1 case of immediate bleeding after EUS-FNA. Conclusions: Endoscopic ultrasound is a highly effective and relatively safe method of diagnosis for gastrointestinal- pancreaticobiliary diseases. Key words: endoscopic ultrasound, gastrointestinal and pancreaticobiliary diseases


2021 ◽  
Vol 22 (23) ◽  
pp. 12839
Author(s):  
Enrico C. Nista ◽  
Tommaso Schepis ◽  
Marcello Candelli ◽  
Lucia Giuli ◽  
Giulia Pignataro ◽  
...  

Pancreatic cystic lesions are increasingly detected in cross-sectional imaging. Intraductal papillary mucinous neoplasm (IPMN) is a mucin-producing subtype of the pancreatic cyst lesions arising from the pancreatic duct system. IPMN is a potential precursor of pancreatic cancer. The transformation of IPMN in pancreatic cancer is progressive and requires the occurrence of low-grade dysplasia, high-grade dysplasia, and ultimately invasive cancer. Jaundice, enhancing mural nodule >5 mm, main pancreatic duct diameter >10 mm, and positive cytology for high-grade dysplasia are considered high-risk stigmata of malignancy. While increased levels of carbohydrate antigen 19-9 (CA 19-9) (>37 U/mL), main pancreatic duct diameter 5–9.9 mm, cyst diameter >40 mm, enhancing mural nodules <5 mm, IPMN-induced acute pancreatitis, new onset of diabetes, cyst grow-rate >5 mm/year are considered worrisome features of malignancy. However, cross-sectional imaging is often inadequate in the prediction of high-grade dysplasia and invasive cancer. Several studies evaluated the role of humoral and intra-cystic biomarkers in the prediction of malignancy in IPMN. Carcinoembryonic antigen (CEA), CA 19-9, intra-cystic CEA, intra-cystic glucose, and cystic fluid cytology are widely used in clinical practice to distinguish between mucinous and non-mucinous cysts and to predict the presence of invasive cancer. Other biomarkers such as cystic fluid DNA sequencing, microRNA (mi-RNA), circulating microvesicles, and liquid biopsy are the new options for the mini-invasive diagnosis of degenerated IPMN. The aim of this study is to review the literature to assess the role of humoral and intracystic biomarkers in the prediction of advanced IPMN with high-grade dysplasia or invasive carcinoma.


2020 ◽  
Vol 35 (2) ◽  
pp. 100-104
Author(s):  
Maksudur Rahman ◽  
Mohammad Abdullah Al Mamun ◽  
MAK Azad Chowdhury ◽  
Abu Sayeed Munsi

Background: Recently it has been apprehended that sildenafil, a drug which has been successfully using in the treatment of PPHN and erectile dysfunction in adult, is going to be withdrawn from the market of Bangladesh due to threat of its misuses. Objective: The aim of this study was to see the extent of uses of sildenafil in the treatment of PPHN and importance of availability of this drugs in the market inspite of its probable misuses. Methods: This cross sectional study was conducted in neonatal intensive care unit (NICU), special baby care unit (SCABU) and cardiac intensive care unit (CICU) of Dhaka Shishu (Children) Hospital from June, 2017 to May 2018. Neonates with PPHN were enrolled in the study. All cases were treated with oral sildenefil for PPHN along with others management according to hospital protocol. Data along with other parameters were collected and analyzed. Results: Total 320 patients with suspected PPHN were admitted during the study period. Among them 92 (29%) cases had PPHN. Male were 49(53 %) cases and female were 43(47%) cases. Mean age at hospital admission was 29.7±13.4 hours. Based on echocardiography,13(14%) cases had mild, 38 (41%) cases moderate and 41(45%) cases severe PPHN. Mean duration of sildenafil therapy was 11.9±7.1 days. Improved from PPHN were 83 (90%) cases. Mortality was 10% (9). Conclusion: In this study it was found that the incidence of PPHN is 29% among the suspected newborns. Sildenafil is successfull in improving the oxygenation of PPHN and to decrease the mortality of neonates. DS (Child) H J 2019; 35(2) : 100-104


2012 ◽  
Vol 2 (2) ◽  
pp. 345-350
Author(s):  
Dr. Girish.L Dandagi ◽  
◽  
Venkat kalyana kumar. P ◽  
Dr. Dr.Isaac Mathew ◽  
Dr. Dr.G S Gaude Dr. Dr.G S Gaude

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