familary pancreatic cancers, if patients are under EUS surveillance. .... patients; 14 diagnostic (10 for pancreatic cancer, 1 cystic tumor of pancreas, 1 malignant ...
Abstracts
3.5 mm and 3.6mm lesions each were detected in the periphery of the body of the pancreas. FNA cytology revealed neuroendocrine tumors in both. The reason for the initial EUS examinations and the complaints of the patients were unrelated to the findings of the neuroendocrine tumors in the pancreas. Conclusion: This small series of incidental findings of very small panrcreatic lesions may lead to the conclusion that the use of high quality EUS consoles may allow more detailed views, consequently the detection of small lesions not visible on other imaging modalities. This insight may be used in patients with unexplained symptoms in combination with a history of MEN or similar diseases to investigate the pancreas for small neuroendocrine tumors even when other imaging techniques are negative. It could also help for early detection of familary pancreatic cancers, if patients are under EUS surveillance. The detection of these very small lesions provides the benefit of an early diagnosis and treatment.
Su1412 Pancreatic Parenchymal and Ductal Abnormalities Identified by Endoscopic Ultrasound in a Veteran Population Matthew P. Spinn, Raquel E. Davila Digestive and Liver Diseases, University of Texas Southwestern Medical Center & VA North Texas Health Care System, Dallas, TX Background: EUS is useful in the evaluation of pancreatic abnormalities. The prevalence of pancreatic ductal and parenchymal findings in patients undergoing EUS has not been clearly defined. Our aim is to determine the frequency of pancreatic changes in veteran patients undergoing EUS. Methods: Retrospective chart review of patients who underwent EUS at a single tertiary care VA Medical Center from 2006 to 2010. All EUS examinations were performed by one expert ultrasonographer using the Olympus GFUE160 radial echoendoscope. Results: A total of 614 EUS procedures were performed, mean age 62.7 yrs [28-96], 95% M. 162 procedures were excluded due to: aborted exam (30), esophageal stricture precluding pancreatic exam (15), multiple procedures on the same patient (45), no mention of the pancreas (72). A total of 452 procedures/patients were included. 103 patients (23%) had a normal pancreas, mean age 64.8 yrs, 92% M. Seventy-seven percent (349/452) of patients had pancreatic abnormalities, mean age 62.1yrs, 94% M. The frequency and number of abnormal findings seen on EUS are shown in Table 1. There were 151 patients who underwent EUS for pancreatic indications, and 301 for non-pancreatic indications. Of those patients with pancreatic indications, 144/151 (95%) had pancreatic abnormalities; 17 (11%) had chronic pancreatitis (CP) and 28 (19%) had features suggestive of CP based on the Rosemont criteria. 205 of the 301 (68%) patients with nonpancreatic indications had pancreatic abnormalities; 4 (1%) had CP and 31(10%) had findings suggestive of CP. Conclusion: Over 75% of our veteran patients were found to have pancreatic parenchymal and ductal abnormalities. There were also a significant number of patients undergoing EUS for non-pancreatic indications who were found to have abnormalities, and features consistent with or suggestive of chronic pancreatitis. Further studies are needed to determine the significance of the incidental abnormalities in this group of patients with no known pancreatic disease and to determine if these changes will later progress to clinically evident chronic pancreatitis. Table 1. Frequency of Pancreatic and Ductal Abnormalities Parenchymal findings (nⴝ452)
n
Ductal findings (nⴝ452)
n
Heterogeneity 192 (42%) Hyperechoic duct margins 120 (27%) Hyperechoic strands 175 (39%) MPD dilation 52 (12%) Hyperechoic foci w/o shadowing 96 (21%) Irregular MPD contour 33 (7%) Hyperechoic foci w/ shadowing 22 (5%) Dilated side branches 10 (2%) Lobularity 93 (21%) MPD calculi 8 (2%) Mass 58 (13%) MPD stricture 7 (2%) Cyst 44 (10%) Pancreas Divisum 7 (2%)
Su1413 Single-Session Endoscopic Ultrasonography and Endoscopic Retrograde Cholangiopancreatography for Patients With Biliopancreatic Diseases Carme Loras1, Joan B. Gornals-Soler1, Carles Pons1, Sandra Maisterra1, Isabel Catala2, Nuria Pelaez3, Juli Busquets3, Jose Castellote1, Juan Fabregat3, Xavier Xiol1 1 Endoscopy Unit-Digestive Diseases, Hospital Universitari de Bellvitge, L’Hospitalet, Barcelona, Spain; 2Cytology Unit, Hospital Universitari de Bellvitge, L’Hospitalet, Barcelona, Spain; 3General and Digestive Surgery, Hospital Universitari de Bellvitge, L’Hospitalet, Barcelona, Spain Objectives: Endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are often required in the evaluation and
treatment of patients with pancreaticobiliary disorders. Few studies of singlesession EUS-ERCP have been reported. The aim of this study is to report our experience and to assess the clinical impact of a single session EUS-ERCP in our centre. Aims & Methods: Data from 2009 to 2010 were reviewed from a prospective EUS-ERCP database at a single tertiary hospital. Indications, sensitivity of EUS and fine-needle aspiration (FNA), duration of the procedure, bile duct cannulation rate, stents and complications were evaluated. Results: Of the 22 patients (13 men and 9 women, mean age 65)and 23 procedures were studied. 14 had a final diagnosis of tumour (12 pancreatic cancer, 1 ampuloma and 1 malignant adenopathy compression), 3 choledocholithiasis, 1 pseudocyst, 1 cystic tumour, 3 benign biliary stricture and 1 uncertain biliary stenosis. All the patients underwent therapeutic ERCP and EUS. In 21 cases EUS was the first procedure performed, except in 2 cases that required an EUS-guided Rendezvous after standard ERCP failed. Only in 1 case, the whole procedure was performed with the same linear echoendoscope. EUS guided puncture was performed in 19 patients; 14 diagnostic (10 for pancreatic cancer, 1 cystic tumor of pancreas, 1 malignant adenopathy, 1 atypia, 1 inflammatory), 2 non representative, and 2 therapeutics. The overall sensitivity of EUS-FNA was 87.5 % (14/16) and for malignancy was 91.6 % (11/12). The bile/pancreatic duct cannulation rate during ERCP was 72.7% (6 failed). During ERCP, endoscopic sphincterotomies were performed in 17 patients (including 5 precut with Needle-Knife), and stents were successfully placed in 15 patients (13 biliary/2 pancreatic) after EUS-FNA/EUS was performed. No major complications occurred and no contrast leak was observed when FNA was performed. The mean duration of the procedure (EUS, with or without FNA plus ERCP) was 72 min. Conclusion: Combined EUS and therapeutic ERCP is safe and technically feasible with no major complications, providing at the same time an accurate diagnosis and specific treatment of biliopancreatic diseases with similar efficacy to the procedures performed separately.
Su1414 The Spectrum of Endoscopic Ultrasound Intervention in Biliary Diseases: A Single Center’s Experience in 31 Cases Bancha Ovartlarnporn, Siriboon Attasaranya, Nisa Netinatsunton, Theeratus Jongboonyanuparp, Teerha Piratvisuth Faculty of Medicine, NKC Institute, Hat Yai, Thailand Introduction: EUS guided intervention (EGI) including EUS guided drainage of bile duct, gallbladder and bilomas has been used increasing in recent years.Aims. To describe the spectrum and experience of EUS guided interventions in biliary diseases in our center.Materials and methods. All patients with EGI were analyzed retrospectively by retrieving data from a prospectively stored endoscopic database between January 2006 and September 2010. Results: There were 31 cases with EGIs (17 female, 14 male) with a mean age ⫹ SD of 58.03 ⫹ 16.89 years and a range of 11 to 88 years. The diagnosis included periampullary or pancreatic cancer in 17, gastric cancer in 1, duodenal cancer in 1, pancreatic inflammatory pseudotumor in 1, metastatic cancer in 2, choledochojejunostomy stenosis in 3, gallstone with cholecystitis in 1, post ERCP cholecystitis in 1, CBD stone in 1, bile leak in 1, hilar cholangiocarcinoma in 1and biloma with bile leak post LC in 1. The indications for EGI were obstructive jaundice in 16, cholangitis in 9, cholecystitis in 2, choledochojejunostomy stenosis in 1, to replace percutaneous transhepatic biliary drainage (PTBD) in 1, bile leak in 1 and biloma in 1. The reasons for EGI were failed ERCP in 24, surgical altered anatomy in 4, acute cholecystitis in 2 and biloma in 1. The median follow-up time in 28 patients with follow-up data was 3.4 months with a range of 0.25-21.50 months. Fourteen patients died, ten patients were still alive and seven patients defaulted during the follow-up. The EGIs were technically successful in 24 of 31 (77.4%). The procedures included 16 hepaticogastrostomy (HG) with 3 failures, 9 choledochoduodenostomy with 3 failures, 4 cholecystoduodenostomy with 1 failure, 1 antegrade placement of metallic stent in CBD and 1 biloma drainage. Covered metallic stents were inserted in 4 and plastic stents were inserted in 22. The number of success for the first 3 years was 8 of 13 procedures (61.5%) and for the last 2 years was 16 of 18 procedures (88.9%) but the difference was not significant.(p⫽0.072) 23 of 25 with stent in place had clinical success in term of symptoms improvement. There were 11 complications in 31 procedures (35.48%). The complications were minor in 7 (22.58%) and major in 4 (12.9%). The number of complications for the first 3 years was 7 of 13 procedures (53%) and for the last 2 years was 4 of 18 procedures (22%) but the difference was not significant. (p⫽0.087). Conclusion: The EUS guided drainage for biliary obstruction, acute cholecystitis, bile leak and biloma was an attractive alternative. The success rate increased and complication rate decreased with increased experience.
Su1415 Role of EUS in the Diagnosis and Management of Indeterminate Pancreatic Cysts Hiang Keat Tan, Khoon-Lin Ling, Steven Mesenas Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore Introduction: Cystic lesions of the pancreas are detected with increasing frequency with the widespread use of cross sectional imaging. Encoscopic
AB258 GASTROINTESTINAL ENDOSCOPY Volume 73, No. 4S : 2011
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