Imaging Finding Analysis and Prognosis Comparison of Pancreatic Head Cancer Invading the Peripheral Nerve Plexus Among Different Groups

Background: To compare imaging features and analyze prognostic differences among different groups with pancreatic head cancer invading the peripheral nerve plexus. Methods: We reviewed preoperative multislice spiral CT (MSCT) images, complete surgical records, and postoperative pathological results of 93 patients with pancreatic head cancer and peripheral nerve invasion. Two radiologists who were unaware of surgical and pathological results evaluated the MSCT images to determine peripheral nerve invasion of pancreatic head cancer. A pathologist who was unaware of the imaging findings grouped the patients based on surgical records and pathological findings. Pancreatic head cancer invasion of the anterior neural pathway was assigned to group A and invasion of pancreatic plexus 1, pancreatic plexus 2, and root of the mesenteric pathway to group B. Both groups were evaluated for peripheral nerve invasion, tumor size, dilatation of the common bile duct/main pancreatic duct, duodenal invasion, and prognosis of pancreatic head cancer.Results: A mass- and strand-like pattern or coarse reticular pattern was frequently observed when two groups of pancreatic head cancer invaded the peripheral nerve plexus. Intergroup differences in tumor size and common bile duct/main pancreatic duct dilatation were insignificant. The duodenal invasion rate was higher in group A than in group B; however, the intergroup difference was insignificant. The prognosis was poorer for group A than for group B.Conclusions: Although the intergroup differences in radiographic findings were not significant, the prognosis was poorer for group A than for group B.

COLODUODENAL FISTULA IN RIGHT COLORECTAL CANCER: CASE REPORT AND REVIEW OF THE LITERATURE

In spite of the high incidence of colorectal cancer, cases of right colon cancer presenting with local invasion are not common. This is even more infrequent if we focus on duodenal invasion and presence of duodenal fistula. We present the case of a patient admitted to our hospital due to severe weight loss, malnutrition and bowel obstruction. The patient was diagnosed of advanced right colon cancer with coloduodenal fistula and concomitant liver metastasis. According to diagnosis, palliative surgery was performed

Endoscopic ultrasonography-guided cholecystogastrostomy in a patient with pancreatic cancer: the first case in Colombia (with video)

The current treatment of malignant biliary obstruction is non-surgical biliary diversion with palliative intent, the surgery having specific indications in patients with malignant pathology with curative intent. However, duodenal obstruction and non-dilated intra- or extrahepatic bile duct make these surgical and endoscopic procedures guided by EUS difficult. We present our experience with the first case in Colombia a third-world country in Latin America of a cholecystogastrostomy guided by EUS in a patient with unresectable pancreatic cancer and duodenal invasion with dilated common bile duct using a luminal stent (LAMS) (HOT stent AXIOS; Xlumena Inc., Mountain View, CA, USA) 15mm x 10mm.EUS-guided cholecystogastrostomy should be considered as an option for biliary decompression of greater importance than percutaneous drainage since it is superior in terms of technical feasibility, safety and efficacy in specific cases of ampullary stenosis and duodenal invasion. In addition, it can be done in third world countries when it has the appropriate training and implements. The fully covered metal stent applied to light (HOT AXIOS stent, Xlumena Inc., Mountain View, CA, USA) is ideal for EUS guided cholecystogastrostomy to minimize complications such as bile leakage. Additional comparative studies are needed to validate the benefits of this technique.

EUS-guided biliary drainage versus ERCP for first-line palliation of malignant distal biliary obstruction: A systematic review and meta-analysis

Endoscopic retrograde cholangiopancreatography (ERCP) with transpapillary metal stenting is the standard palliation method for malignant distal biliary obstruction (MDBO); however, post-ERCP pancreatitis are not uncommon. Endoscopic ultrasonography-guided biliary drainage (EUS-BD) with transmural metal stenting has emerged as an option for primary palliation of MDBO. We compared the efficacy and safety of these procedures as first-line MDBO treatment. We searched for relevant English-language articles in PubMed, Embase, and Cochrane databases. The outcomes of interest were technical success, clinical success, adverse events, stent patency, reintervention rates, and procedure time. Subgroup analysis was performed for patients without duodenal invasion (eg, endoscopically accessible papilla; EUS-choledochoduodenostomy [CDS] vs. ERCP). Ten studies (3 randomized trials and 7 retrospective studies) with 756 patients were included. The cumulative technical and clinical success rates were high for both procedures (EUS-BD: 94.8% [294/310] and 93.8% [286/305], ERCP: 96.5% [386/400] and 95.7% [377/394]). The cumulative adverse event rates were 16.3% (54/331) for EUS-BD and 18.3% (78/425) for ERCP. In subgroup analysis for patients without duodenal invasion, EUS-CDS showed similar cumulative technical and clinical success rate with ERCP (technical success rate, EUS-CDS vs. ERCP: 94.2% [146/155] vs. 97.8% [237/242]; clinical success rate, EUS-CDS vs. ERCP: 94.2% [145/154] vs. 93.0% [225/242]). The cumulative rate of adverse events for EUS-CDS and ERCP was also comparable (15.5% [24/155] for EUS-CDS and 18.6% [45/242] for ERCP). As first-line palliation of MDBO, EUS-BD was similar to ERCP in technical and clinical success and safety; however, larger randomized trials comparing EUS-CDS and ERCP in this setting with endoscopically accessible papilla may be required.