RESUMEN
BACKGROUND: EUS-guided FNA has been well documented to aid in the diagnosis of subepithelial lesions by providing cytologic material. Studies to date evaluating the sensitivity of EUS-FNA for the diagnosis of GI stromal cell tumors (GIST) have been small, and few have relied on surgical histologic diagnosis as the reference standard. OBJECTIVE: Our purpose was to determine the diagnostic yield and sensitivity of EUS-FNA for the diagnosis of GIST and to identify EUS features of GIST that are predictive of the ability to obtain adequate tissue by EUS-FNA. DESIGN: All patients with histologically confirmed, c-kit-positive GIST who underwent EUS-FNA from 1998 to 2006 were reviewed. EUS images were examined for mass size, shape, location, wall layer, heterogeneity, echogenicity, cystic spaces, lobulation, ulceration, and central umbilication. Needle gauge, number of needle passes, and presence of a cytologist during the EUS-FNA were recorded. RESULTS: A total of 37 patients (29 with diagnostic FNA cytology; 8 with nondiagnostic cytology) met the inclusion criteria. The diagnostic yield and sensitivity of EUS-FNA cytology for the diagnosis of GIST was 78.4% (29/37). The sensitivity was 84.4% (27/32) for GISTs located in the stomach, but poor for lesions located in the duodenum because none of these tumors yielded diagnostic cytology (n = 3). An increase in size up to 10 cm, round/oval shape, and identification of the origin of GIST within a specific sonographic wall layer were statistically significant in their ability to predict adequate tissue yield. CONCLUSIONS: The sensitivity of EUS-FNA cytology for the diagnosis of GIST is 78.4% and is influenced by size, location, shape, and layer of origin.
Asunto(s)
Biopsia con Aguja Fina/métodos , Endosonografía , Tumores del Estroma Gastrointestinal/patología , Anciano , Femenino , Tumores del Estroma Gastrointestinal/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
A case is presented of rectal carcinoma in which during staging by endoscopic ultrasound (EUS) a second large extrarectal mass was seen not otherwise visualized on computer tomography (CT) that was a solitary ovarian metastasis. The surgeon was alerted to the EUS finding prior to the planned laparoscopic colectomy. On retrospective review of the CT pelvis after surgery, the radiologist could still not diagnose the ovarian lesion separated from the primary rectal tumor due to their close proximity. However, on EUS we were able to clearly see on real-time imaging that there was a distinct peri-rectal mass apart from the primary rectal tumor.
Asunto(s)
Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/secundario , Neoplasias Colorrectales/patología , Neoplasias Ováricas/diagnóstico por imagen , Neoplasias Ováricas/secundario , Endosonografía , Femenino , Humanos , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Mast cells have a primary role in atopy. Mast cells may play a unique role in a subgroup of patients with irritable bowel syndrome (IBS). This observation suggests a link between atopic disorders and IBS. OBJECTIVE: To determine whether there is an association between atopic disorders and IBS. METHODS: We undertook a prospective study using structured questionnaires. We administered questionnaires to 125 consecutive patients seen in the following clinics from July 1 through October 31, 2001: allergy/immunology (AI) (n = 39), gastroenterology (n = 36), and general medicine (n = 50). The survey included questions detailing gastrointestinal and allergic symptoms. Diagnosis of IBS was based on Rome II criteria. Diagnosis of atopy was based on clinical parameters. RESULTS: The AI clinic reported a significantly (P = .015) higher rate of IBS than the general medicine clinic. The IBS incidence reported in the AI clinic was similar to that reported in the gastroenterology clinic. The likelihood of IBS was significantly higher in patients with seasonal allergic rhinitis (2.67 times; 95% confidence interval [CI], 1.10-6.49; P = .03), patients with allergic eczema (3.85 times; 95% CI, 1.72-8.60; P = .001), and patients with depression (2.56 times; 95% CI, 1.05-6.14; P = .04). Patients reporting atopic symptoms (seasonal allergic rhinitis, allergic eczema, and asthma) were 3.20 times (95% CI, 1.20-8.50) (P = .02) more likely to fulfill the criteria for IBS. CONCLUSIONS: Adults with atopic symptoms report a high incidence of IBS, suggesting a link between atopy and IBS. We proposed a subgroup of patients with IBS (atopic IBS) who have typical IBS symptoms in association with atopic manifestations. Identifying atopic vs nonatopic IBS may help in identifyingthe underlying pathophysiologic mechanisms and therapeutic options.
Asunto(s)
Hipersensibilidad/diagnóstico , Hipersensibilidad/inmunología , Síndrome del Colon Irritable/inmunología , Encuestas y Cuestionarios , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Asma/inmunología , Depresión/inmunología , Dermatitis Alérgica por Contacto/inmunología , Femenino , Hipersensibilidad a los Alimentos/inmunología , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Prospectivos , Rinitis Alérgica Estacional/inmunología , Factores de RiesgoRESUMEN
Malignant biliary obstruction is most commonly managed by the endoscopist. Various plastic and metal stents are currently available. It is important to be aware of the pros and cons of each. The identifying factors that determine the prognosis for the patient might also help determine which type of stent to place. This month's article by Moss et al., is a meta-analysis of seven randomized controlled trials analyzing the cost-effectiveness of plastic and metal stents. This meta-analysis helps guide the endoscopist in deciding what type of stent would be most beneficial and cost effective for their patients.
Asunto(s)
Neoplasias de los Conductos Biliares/complicaciones , Colestasis/terapia , Metales , Plásticos , Stents/normas , Colestasis/etiología , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Pancreatic cystic lesions are detected more frequently as a result of increasing use of high-resolution cross-sectional imaging. The ability of imaging and cyst fluid analysis to predict the biologic behavior of the lesions has aroused much interest recently. A precise diagnosis is critical to help guide further management. The diagnostic criteria and the management principles have evolved dramatically over the past 10 years with the advent of endoscopic ultrasound and fine-needle aspiration. In this review, we summarize the recent publications that have examined the key issues in the diagnosis and management of cystic lesions of the pancreas.
Asunto(s)
Cistoadenoma/diagnóstico , Quiste Pancreático/diagnóstico , Amilasas/análisis , Pancreatocolangiografía por Resonancia Magnética , Cistoadenoma/diagnóstico por imagen , Cistoadenoma Mucinoso/diagnóstico , Cistadenoma Seroso/diagnóstico , Endosonografía , Humanos , Quiste Pancreático/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Distinguishing mucinous from nonmucinous cystic lesions of the pancreas often constitutes a diagnostic dilemma. The clinical management differs between such lesions; therefore it is important to make an accurate preoperative diagnosis. Various centers have reported conflicting results regarding their ability to detect mucin-producing neoplastic cells and appropriately reach a diagnosis based on endoscopic ultrasound (EUS) guided FNA. The aim of this study is to assess the ability of EUS-FNA cytology to diagnose and differentiate mucinous from nonmucinous pancreatic cystic lesions. We reviewed records of patients who underwent EUS of pancreatic cystic lesions. If FNA was performed and mucinous neoplasm was suspected, aspirate was evaluated for cytomorphology and presence of mucin. FNA results were compared to final histologic diagnosis if surgery was performed. Cytologic diagnosis was provided for 28/30 (93%). By comparing EUS-FNA diagnoses with final surgical pathology, FNA accurately diagnosed in 10/11 cases with sensitivity and specificity for detection of malignancy of 100 and 89, respectively, while the accuracy for identification of mucinous cystic neoplasms was 100%. Our results indicate that in the appropriate clinical and imaging setting, EUS-FNA cytology with analysis for mucin production by tumor cells is an important test in distinguishing pancreatic cystic lesions and guiding further management.
Asunto(s)
Biopsia con Aguja Fina/métodos , Endosonografía/métodos , Quiste Pancreático/patología , Adulto , Anciano , Biomarcadores/metabolismo , Cistadenocarcinoma Mucinoso/patología , Cistoadenoma Mucinoso/patología , Diagnóstico Diferencial , Endosonografía/instrumentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mucinas/metabolismo , Quiste Pancreático/metabolismo , Quiste Pancreático/cirugía , Neoplasias Pancreáticas/patología , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
Pancreatic cysts are being detected with increasing frequency. These lesions may be pseudocysts, serous cystadenomas, mucinous neoplasms, or other rare pancreatic malignancies. It is important to differentiate among the various cystic lesions in order to further guide management. We review the role of endoscopic ultrasound, fine needle aspiration including cytology, and tumor markers in the evaluation of these cystic tumors. We also discuss emerging concepts in the management of cystic pancreatic tumors.
Asunto(s)
Angiodisplasia/terapia , Enfermedades del Ciego/terapia , Hemorragia Gastrointestinal/terapia , Hemostasis Endoscópica/instrumentación , Stents , Anciano , Angiodisplasia/complicaciones , Angiodisplasia/diagnóstico , Enfermedades del Ciego/complicaciones , Enfermedades del Ciego/diagnóstico , Colonoscopía/métodos , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Reestenosis Coronaria/diagnóstico por imagen , Reestenosis Coronaria/terapia , Seguridad de Equipos , Estudios de Seguimiento , Hemorragia Gastrointestinal/etiología , Hemostasis Endoscópica/métodos , Humanos , Masculino , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/cirugía , Radiografía , Medición de Riesgo , Prevención Secundaria , Instrumentos Quirúrgicos , Terapia Trombolítica/efectos adversos , Terapia Trombolítica/métodos , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
Endoscopic ultrasound (EUS) is a valuable tool in gastrointestinal endoscopy, with various applications such as diagnosis, staging, and evaluation of the pancreaticobiliary system. EUS has comparable sensitivity to magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) for detection of choledocholithiasis. EUS may be considered for evaluation for choledocholithiasis as prelude to ERCP when there is a low to intermediate suspicion for common bile duct stones or when there is an increased risk for complications from ERCP. Endosonography may also be useful in the evaluation of cholangiocarcinoma. Intraductal ultrasound within the bile duct may help differentiate malignant from benign strictures. EUS-guided fine needle aspiration can be helpful in the diagnosis of cholangiocarcinoma, especially in the region of the hilum.