RESUMEN
BACKGROUND AND STUDY AIMS: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is now performed routinely in many advanced endoscopy centers and has enhanced the ability to diagnose pancreatic masses. However, there is uncertainty about which needle size is optimal for EUS-FNA of pancreatic masses. We aimed to evaluate the performance of the 22-gauge and 25-gauge needles in obtaining cytologic diagnosis of pancreatic masses. METHODS: All cases that were referred for EUS-FNA for pancreatic masses between February 2001 and June 2007 were reviewed, and patients who underwent EUS-FNA using the 22-gauge and 25-gauge needle system were identified. In patients who underwent surgery, operative histopathological findings were compared with the cytopathological findings from EUS-FNA. RESULTS: A total of 842 patients with pancreatic masses detected on computed tomography (CT) and/or magnetic resonance imaging (MRI) and confirmed by EUS underwent EUS-FNA with the 22-gauge needle (n = 540) or the 25-gauge needle (n = 302). Results of EUS-FNA cytology findings were compared with the gold standard of surgical histopathological findings or long-term clinical follow-up. The sensitivity, specificity, PPV, and NPV of FNA were respectively 84%, 100%, 100%, and 73% [corrected] for the 22-gauge needle compared with 92%, 97%, 98%, and 87%, [corrected] respectively for the 25-gauge needle. No complications were noted in the 25-gauge needle group, compared with pancreatitis in 2% of the 22-gauge needle group. CONCLUSIONS: This retrospective comparative study shows that EUS-FNA with a 25-gauge needle system is a safe and reliable method for tissue sampling in pancreatic masses. The system is more sensitive and has a slightly [corrected] higher NPV than the standard 22-gauge needle. Our study suggests that perhaps the smaller caliber FNA needle causes less trauma during EUS-FNA and hence less complications. Further studies including randomized trials are needed.
Asunto(s)
Biopsia con Aguja Fina/instrumentación , Endosonografía/instrumentación , Neoplasias Pancreáticas/patología , Ultrasonografía Intervencional/instrumentación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Fina/efectos adversos , Diagnóstico Diferencial , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Agujas , Páncreas/patología , Pancreatitis/etiología , Estudios Retrospectivos , Sensibilidad y Especificidad , Adulto JovenAsunto(s)
Carcinoma de Células Pequeñas/diagnóstico , Gastroscopía , Neoplasias Gástricas/diagnóstico , Biopsia , Carcinoma de Células Pequeñas/patología , Femenino , Mucosa Gástrica/patología , Humanos , Persona de Mediana Edad , Necrosis , Neoplasias Gástricas/patología , Úlcera Gástrica/diagnóstico , Úlcera Gástrica/patología , Úlcera Gástrica/cirugía , Tomografía Computarizada por Rayos XAsunto(s)
Endosonografía , Enfermedades del Esófago/diagnóstico por imagen , Esófago/diagnóstico por imagen , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Biopsia con Aguja Fina , Diagnóstico Diferencial , Enfermedades del Esófago/patología , Enfermedades del Esófago/cirugía , Neoplasias Esofágicas/diagnóstico por imagen , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/cirugía , Esofagectomía , Esófago/patología , Esófago/cirugía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The authors present the first case report of a 50-year-old woman with a 33-year history of severe, chronic watery diarrhea and hypokalemia secondary to chronic active microscopic enterocolitis with patterns similar to lymphocytic colitis but with acute cryptitis and terminal ileum involvement microscopically. The progressive nature of her illness resulted in multiple hospital admissions secondary to hypokalemia with subsequent chronic renal failure. High continuous doses of oral potassium supplements failed to correct the hypokalemic episodes. After subtotal colon resection, the patient made a marked clinical improvement with normal serum potassium levels without receiving potassium supplementation.