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Pancreatic cancer, endoscopic ultrasound, ercp

Vishal B Gohil, Jason B Klapman
Pancreas cancer is a fourth-leading cause of cancer death in the USA and its incidence is rising as the population is aging. The majority of patients present at an advanced stage due to the silent nature of the disease and treatment have focused more on palliation than curative intent. Gastroenterologists have become integral in the multidisciplinary care of these patients with a focus on providing endoscopic palliation of pancreas cancer. The three most common areas that gastroenterologists palliate endoscopically are biliary obstruction, cancer-related pain, and gastric outlet obstruction...
August 9, 2017: Current Treatment Options in Gastroenterology
Marianna Signoretti, Roberto Valente, Alessandro Repici, Gianfranco Delle Fave, Gabriele Capurso, Silvia Carrara
Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP)-guided ablation procedures are emerging as a minimally invasive therapeutic alternative to radiological and surgical treatments for locally advanced pancreatic cancer (LAPC), pancreatic neuroendocrine tumours (PNETs), and pancreatic cystic lesions (PCLs). The advantages of treatment under endoscopic control are the real-time imaging guidance and the possibility to reach a deep target like the pancreas. Currently, radiofrequency probes specifically designed for ERCP or EUS ablation are available as well as hybrid cryotherm probe combining radiofrequency with cryotechnology...
February 16, 2017: World Journal of Gastrointestinal Endoscopy
Yoshihiro Kishida, Hiroyuki Matsubayashi, Keiko Sasaki, Shinsaku Honda, Sunao Uemura, Katsuhiko Uesaka, Akiko Todaka, Hiroyuki Ono
BACKGROUND: Histological confirmation is needed when the pancreatic lesions is uncertain for neoplastic or nonneoplastic. Current case with multicentric pancreatic carcinomas showing indefinite clinical images was successfully diagnosed by a biopsy of a novel object expelled from the papilla. CASE PRESENTATION: A 71-year-old male was referred because of elevated serum pancreatic enzymes. Computed tomography revealed an unclear low-density area in the pancreatic body without evidence of tumor and mild dilation of the upstream main pancreatic duct (MPD)...
January 23, 2017: BMC Gastroenterology
QiuBo Zhang, ShaoJie Chen, LinJuan Zeng, YinTing Chen, GuoDa Lian, ChenChen Qian, JiaJia Li, RuiJie Xie, Kai-Hong Huang
Pancreatic cancer is an aggressive carcinoma of the digestive system and radical resection, which is available to very few patients, is the only possibility for cure. Since therapeutic choices are limited at the advanced stage, screening and early diagnostic tools are indispensable for a better prognosis. Areas covered: This review illustrates serologic and imaging examinations, and carbohydrate antigens, microRNAs, methylation biomarkers, molecules in exosomes, ultrasound, computed tomography, magnetic resonance imaging, positron emission tomography and endoscopic retrograde cholangiopancreatography, among other topics...
February 2017: Expert Review of Gastroenterology & Hepatology
Ajaypal Singh, Ashley L Faulx
Early diagnosis and accurate staging of pancreatic cancer is very important to plan optimal management strategy. Endoscopy plays an important role in the diagnosis and management of pancreatic cancer. Endoscopic ultrasound imaging (EUS) is the most sensitive modality for diagnosis, especially for small pancreatic tumors; it also allows tissue acquisition for histological diagnosis. Computed tomography scanning and EUS play complementary roles in staging and are comparable in determining resectability. Endoscopic retrograde cholangiopancreatography allows tissue sampling but is limited to palliative biliary drainage in most cases...
December 2016: Surgical Clinics of North America
Andrew C Storm, Linda S Lee
The diagnostic approach to a possible pancreatic mass lesion relies first upon various non-invasive imaging modalities, including computed tomography, ultrasound, and magnetic resonance imaging techniques. Once a suspect lesion has been identified, tissue acquisition for characterization of the lesion is often paramount in developing an individualized therapeutic approach. Given the high prevalence and mortality associated with pancreatic cancer, an ideal approach to diagnosing pancreatic mass lesions would be safe, highly sensitive, and reproducible across various practice settings...
October 21, 2016: World Journal of Gastroenterology: WJG
Kazuya Matsumoto, Yohei Takeda, Takumi Onoyama, Soichiro Kawata, Hiroki Kurumi, Masaru Ueki, Norimasa Miura, Hajime Isomoto
Pancreatic cancer is the fifth leading cause of cancer death and has the lowest survival rate of any solid cancer. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) is currently capable of providing a cytopathological diagnosis of pancreatic malignancies with a higher diagnostic power, with a sensitivity and specificity of 85%-89% and 98%-99%, compared to pancreatic juice cytology (PJC), whose sensitivity and specificity are only 33.3%-93% and 83.3%-100%. However, EUS-FNA is not effective in the cases of carcinoma in situ and minimally invasive carcinoma because both are undetectable by endoscopic ultrasonography, although PJC is able to detect them...
September 15, 2016: World Journal of Gastrointestinal Oncology
Farah Adel, José Manuel Ramia, Luis Gijón, Roberto de la Plaza-Llamas, Vladimir Arteaga-Peralta, Carmen Ramiro-Perez
BACKGROUND: Cystic echinococcosis is a zoonosis caused by larvae of the parasite Echinococcus that is endemic in many countries of the Mediterranean area. It can affect any organ, with the most common sites being liver (70%) and lung (20%). Splenic hydatid disease, despite being rare, is the third most common location. Other locations such as bone, skin, or kidney are exceptional. OBJECTIVE: To present our experience in extrahepatic and extrapulmonary hydatidosis...
September 5, 2016: Cirugia y Cirujanos
Alexandra Kalogeraki, Georgios Z Papadakis, Dimitrios Tamiolakis, Iliana Karvela-Kalogeraki, Mihailos Karvelas-Kalogerakis, John Segredakis, Michael Papadakis, Eleni Moustou, Galateia Datseri, Maria Tzardi
Solid masses of the pancreas represent a variety of benign and malignant neoplasms of the exocrine and endocrine tissues of the pancreas. A tissue diagnosis is often required to direct therapy in the face of uncertain diagnosis or if the patient is not a surgical candidate either due to advanced disease or comorbidities. Endoscopic ultrasound (EUS) is a relatively new technology that employs endoscopy and high-frequency ultrasound (US). EUS involves imaging of the pancreatic head and the uncinate from the duodenum and imaging of the body and tail from the stomach...
January 2016: Romanian Journal of Internal Medicine, Revue Roumaine de Médecine Interne
Mouen A Khashab, Schalk Van der Merwe, Rastislav Kunda, Mohamad H El Zein, Anthony Y Teoh, Fernando P Marson, Carlo Fabbri, Ilaria Tarantino, Shyam Varadarajulu, Rani J Modayil, Stavros N Stavropoulos, Irene Peñas, Saowanee Ngamruengphong, Vivek Kumbhari, Joseph Romagnuolo, Raj Shah, Anthony N Kalloo, Manuel Perez-Miranda, Everson L Artifon
BACKGROUND AND AIMS: Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative to traditional radiologic and surgical drainage procedures after failed endoscopic retrograde cholangiopancreatography (ERCP). However, prospective multicenter data are lacking. The aims of this study were to prospectively assess the short- and long-term efficacy and safety of EUS-BD in patients with malignant distal biliary obstruction. PATIENTS AND METHODS: Consecutive patients at 12 tertiary centers (5 US, 5 European, 1 Asian, 1 South American) with malignant distal biliary obstruction and failed ERCP underwent EUS-BD...
April 2016: Endoscopy International Open
Stephen Y Oh, Shayan Irani, Richard A Kozarek
Pancreatic adenocarcinoma is the fourth leading cause of cancer-related death in the United States. Due to the aggressive tumor biology and late manifestations of the disease, long-term survival is extremely uncommon and the current 5-year survival rate is 7%. Over the last two decades, endoscopic ultrasound (EUS) has evolved from a diagnostic modality to a minimally invasive therapeutic alternative to radiologic procedures and surgery for pancreatic diseases. EUS-guided celiac plexus intervention is a useful adjunct to conventional analgesia for patients with pancreatic cancer...
April 10, 2016: World Journal of Gastrointestinal Endoscopy
Erik Bowman, Jacob Greenberg, Michael Garren, Nalini Guda, Brian Rajca, Mark Benson, Patrick Pfau, Anurag Soni, Andrew Walker, Deepak Gopal
BACKGROUND: Patients with Roux-en-Y gastric bypass (RYGB) develop pancreatobiliary issues after surgery. Endoscopic management via the conventional route with endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) is quite limited due to the altered anatomy. Laparoscopic-assisted ERCP (LA-ERCP) via the excluded stomach has been highly successful. Reported use of laparoscopic-assisted EUS (LA-EUS) is extremely rare. METHODS: A retrospective review was conducted at two tertiary referral centers for cases that involved laparoscopic-assisted ERCP and EUS...
October 2016: Surgical Endoscopy
Ryuichi Yamamoto, Masatomo Takahashi, Yasuyo Osafune, Katsuya Chinen, Shingo Kato, Sumiko Nagoshi, Koji Yakabi
AIM: To evaluate the efficacy and safety of single-step endoscopic placement of self-expandable metallic stents (SEMS) for treatment of obstructive jaundice. METHODS: A retrospective study was performed among 90 patients who underwent transpapillary biliary metallic stent placement for malignant biliary obstruction (MBO) between April 2005 and October 2012. The diagnosis of primary disease and MBO was based on abdominal ultrasound, computed tomography, magnetic resonance imaging, endoscopic ultrasound, endoscopic retrograde cholangiopancreatography with brush cytology, biopsy, and/or a combination of these modalities...
July 25, 2015: World Journal of Gastrointestinal Endoscopy
C Rinaldi A Lesmana, Khek Yu Ho, Laurentius A Lesmana
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a common technique for assessing the pancreas and the biliary system; however, the potential complications have raised concern among endoscopists and patients. Recently, the need of endoscopic ultrasound (EUS) as an additional tool of assessment before the ERCP procedure has been increasing. The need of EUS in developing countries is still a matter of debate regarding the cost, investment, and training. Here, we report the significant impact of EUS on several unselected interesting cases of pancreatobiliary disorders...
May 2015: Case Reports in Gastroenterology
Vishal Sharma, Surinder S Rana, Deepak K Bhasin
Endoscopic ultrasound (EUS) has emerged as an important diagnostic and therapeutic modality in the field of gastrointestinal endoscopy. EUS provides access to many organs and lesions which are in proximity to the gastrointestinal tract and thus giving an opportunity to target them for therapeutic and diagnostic purposes. This modality also provides a real time opportunity to target the required area while avoiding adjacent vascular and other structures. Therapeutic EUS has found role in management of pancreatic fluid collections, biliary and pancreatic duct drainage in cases of failed endoscopic retrograde cholangiopancreatography, drainage of gallbladder, celiac plexus neurolysis/blockage, drainage of mediastinal and intra-abdominal abscesses and collections and in targeted cancer chemotherapy and radiotherapy...
June 10, 2015: World Journal of Gastrointestinal Endoscopy
Michele Tedeschi, Francesco Vittore, Pasquale Di Fronzo, Angela Gurrado, Giuseppe Piccinni, Mario Testini
INTRODUCTION: Autoimmune pancreatitis is now a defined entity and it could mimic a pancreatic malignancy. True oncological emergencies in pregnant patients are rare. CASE REPORT: A 39 years-old pregnant woman was admitted to our emergency unit due to right upper quadrant abdominal pain and evidence of obstructive jaundice. Since computed tomography-scan and endoscopic retrograde cholangiopancreatography are contraindicated in pregnant woman, a cholangio-Nuclear Magnetic Resonance was performed, confirming the biliary tract dilatation with stenosis of the intrapancreatic portion of the common bile duct and a shaded image of a mass in the pancreatic head...
January 2015: Annali Italiani di Chirurgia
Varayu Prachayakul, Pitulak Aswakul
Endoscopic retrograde cholangiopancreatography had been a treatment modality of choice for both benign and malignant biliary tract obstruction for more than half century, with a very high clinical success rate and low complications. But in certain circumstances, such as advanced and locally advanced pancreatobiliary malignancies (pancreatic cancer, cholangiocarcinoma, ampullary tumor) and tight benign strictures, endoscopic retrograde cholangiopancreatography (ERCP) fails. Up to this point, the only alternative interventions for these conditions were percutaneous transhepatic biliary drainage or surgery...
January 16, 2015: World Journal of Gastrointestinal Endoscopy
Hemanth Gavini, Jeffrey H Lee
Over the last 2 decades, endoscopic ultrasound (EUS) has evolved from a noninvasive diagnostic tool to a combined diagnostic and therapeutic modality. The use of EUS complementary to endoscopic retrograde cholangiopancreatography (ERCP) has made possible biliary and pancreatic drainage in situations where conventional ERCP is unsuccessful or unlikely to be feasible. The degree of proximity to the pancreas achieved during the procedure has enabled therapeutic interventions such as drainage of peripancreatic fluid collections, pancreatic cyst ablation, and pancreatic cancer therapy...
March 2015: Journal of Clinical Gastroenterology
M Ashkar, T B Gardner
AIM: Since its introduction, endoscopic ultrasonography (EUS) has been increasingly gaining more attention for diagnosing various gastrointestinal conditions. We aim to systematically review the literature and highlight the benefit of using EUS in different pancreatic diseases by primarily reviewing its importance in diagnosing, treating pancreatic pathologies, comparing its accuracy to other modalities and determining its limitations and complications. METHODS: Using defined (MeSH) terms and keywords; two reviewers conducted a MEDLINE search through August 2014, in addition to manually searching relevant bibliographies cited in the included studies...
December 2014: Minerva Gastroenterologica e Dietologica
John J Kim, Sukhpreet Walia, Scott H Lee, Bhavesh Patel, Madhavi Vetsa, Yan Zhao, Wichit Srikureja, Loren Laine
BACKGROUND: In jaundiced patients with suspected pancreatic cancer, endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent is frequently performed prior to histologic diagnosis by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). AIMS: To compare the accuracy of jaundiced patients undergoing EUS-FNA for a pancreatic mass with or without a biliary stent. METHODS: Consecutive patients with a pancreatic mass and jaundice who underwent EUS-FNA between 4/2005 and 4/2013 were identified...
February 2015: Digestive Diseases and Sciences
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