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Ya-Dong Gao, Ya-Wei Qu, Hai-Feng Liu
OBJECTIVE: The accurate diagnosis of undetermined pancreaticobiliary strictures remains challenging. Current ERCP-guided tissue sampling methods are of low sensitivity. Confocal laser endomicroscopy (CLE) is a new procedure and allows real optical biopsies that may improve the diagnosis of undetermined pancreaticobiliary strictures. The aim of this meta-analysis was to determine the diagnostic yield of CLE, tissue sampling, and CLE combined with tissue sampling for undetermined pancreaticobiliary strictures...
March 15, 2018: Scandinavian Journal of Gastroenterology
Shounak Majumder, Sonmoon Mohapatra, Ryan J Lennon, Guilherme Piovezani Ramos, Neil Postier, Ferga Gleeson, Michael J Levy, Randall K Pearson, Bret T Petersen, Santhi S Vege, Suresh T Chari, Mark Topazian, Thomas E Witzig
BACKGROUND & AIMS: Immunoglobulin G4-related disease (IgG4-RD), a multi-organ fibro-inflammatory syndrome, typically responds to steroids. However, some cases are steroid resistant, and pancreaticobiliary IgG4-RD commonly relapses after steroid withdrawal. Rituximab induces remission of IgG4-RD, but the need for and safety of maintenance rituximab treatment are unknown. We compared outcomes of patients with pancreaticobiliary IgG4-RD treated with or without maintenance rituximab therapy...
March 8, 2018: Clinical Gastroenterology and Hepatology
Amy Tyberg, Isaac Raijman, Ali Siddiqui, Urban Arnelo, Douglas G Adler, Ming-Ming Xu, Najib Nassani, Divyesh V Sejpal, Prashant Kedia, Yun Nah Lee, Frank G Gress, Sammy Ho, Monica Gaidhane, Michel Kahaleh
INTRODUCTION: In patients with pancreaticobiliary lesions anticipating surgical resection, digital pancreaticocholangioscopy can be used to identify the extent of disease. This presurgical"mapping" could change the surgical plan and optimize patient care. MATERIALS AND METHODS: Patients with pancreaticobiliary lesions anticipating surgery who underwent endoscopic retrograde cholangiopancreatography with digital pancreaticocholangioscopy from 9 international centers were included...
March 6, 2018: Journal of Clinical Gastroenterology
Anjum Saeed, Asaad Assiri
Choledochal cyst is not an uncommonly seen entity in children. Presentation may be varied and at different age groups. Abnormal pancreaticobiliary junction is usually a phenomenon in acquired type of choledochal cyst. A four years old child presented with symptoms of acute viral hepatitis A but persistence of symptoms beyond the usual time necessitated other conditions to be considered. Choledochal cyst was the final diagnosis complicating with biliary stone which was managed by surgical excision.
January 2018: Journal of Ayub Medical College, Abbottabad: JAMC
Ravi Nara Srinivasa, Matthew L Osher, Douglas A Murrey, Jordan Bruce Fenlon, Charles Brewerton, Wael E Saad, Jeffrey Forris Beecham Chick
Patients with a Roux-en-Y gastric bypass may be challenging diagnostic and therapeutic dilemmas for gastroenterologists and endoscopists due to anatomic considerations. Pancreaticobiliary limb pathology is particularly difficult to diagnose from standard endoscopic approaches as it often requires double balloon enteroscopy. Percutaneous access and gastrostomy placement into the gastric remnant, however, is a commonly performed procedure by interventional radiology. This report describes the identification of duodenal perforation and Graham patch dehiscence in the pancreaticobiliary limb of a patient with a prior Roux-en-Y gastric bypass who had failed traditional endoscopic measures, using transgastric remnant interventional duodenoscopy and confirmed with methylene blue injection into a periduodenal abscess...
December 2017: Radiology Case Reports
Lynda R Corrigan, Dara M Bracken-Clarke, Anne M Horgan
Pancreatic and biliary tract cancers are aggressive malignancies. They commonly present with metastatic or unresectable disease. Those that do present with resectable cancer have high rates of recurrence. Despite recent advances in surgical technique, chemotherapy, and radiotherapy regimens, they are associated with poor survival outcomes. These cancers represent an exception to the trend of improved overall survival evident in most malignancies in recent decades. Depending on the goal of treatment, active management of pancreatic and biliary cancers involves surgery, chemotherapy, and radiation therapy, either alone or in combination...
January 31, 2018: Current Problems in Cancer
David M Arner, Brooke E Corning, Ali M Ahmed, Henry C Ho, Bradley J Weinbaum, Uzma Siddiqui, Harry Aslanian, Reid B Adams, Todd W Bauer, Andrew Y Wang, Vanessa M Shami, Bryan G Sauer
Background and Objectives: DNA molecular analysis has been suggested as a tool to evaluate pancreatic cysts. This study assesses whether the addition of DNA molecular analysis alters clinical management. Methods: This is a retrospective review of 46 consecutive patients who underwent EUS-FNA of pancreatic cysts with DNA molecular analysis at two major academic institutions. Cases were presented to two pancreaticobiliary surgeons first without and then with DNA molecular analysis data...
January 2018: Endoscopic Ultrasound
Margaret G Keane, Mayur Kumar, Natascha Cieplik, Douglas Thorburn, Gavin J Johnson, George J Webster, Michael H Chapman, Keith J Lindley, Stephen P Pereira
BACKGROUND: In adults ERCP and endoscopic ultrasound (EUS) are standard methods of evaluating and treating many hepatopancreaticobiliary (HPB) conditions. HPB disease is being diagnosed with increasing frequency in children but information about role of ERCP and EUS and their outcomes in this population remain limited. Therefore the aims of this study were to describe the paediatric ERCP and EUS experience from a large tertiary referral HPB centre, and to systematically compare outcomes with those of other published series...
February 9, 2018: BMC Pediatrics
Morikatsu Yoshida, Takeshi Nakaura, Taihei Inoue, Shota Tanoue, Sentaro Takada, Daisuke Utsunomiya, Shota Tsumagari, Kazunori Harada, Yasuyuki Yamashita
OBJECTIVES: The current study evaluated the clinical usefulness of the gradient and spin-echo (GRASE) sequence with single breath-hold in 3.0 T magnetic resonance cholangiopancreatography (MRCP). We compared the acquisition time and image quality between GRASE and breath navigator-triggered 3D turbo spin echo (3D TSE). METHODS: We examined 54 consecutive patients who underwent MRCP with GRASE and 3D TSE. We compared the image acquisition time and contrast-to-noise ratio (CNR) between the common bile duct (CBD) and liver...
January 15, 2018: European Radiology
Sharon J Song, Kathleen Montone, Kristen Stashek, Rashmi Tondon
Pictured here is a portacaval lymph node biopsy from a 72-year-old man with an 11.9 cm liver mass and several enlarged surrounding lymph nodes. The node was involved by a tumor with two distinct morphologies-one area resembling a primary pancreaticobiliary tumor (Figure 1) and another mimicking a thyroid follicular carcinoma with microfollicles containing brightly eosinophilic, colloid-like secretions (Figure 2). Immunohistochemistry showed the neoplastic cells to stain strongly with CK7 and CK19, with patchy positivity for CK20...
December 28, 2017: Liver International: Official Journal of the International Association for the Study of the Liver
Rahul A Sheth, Sharjeel H Sabir, Philip Parmet, Roshon Amin, Joshua D Kuban, Steven Y Huang, Armeen Mahvash, David Fogelman, Milind Javle, Michael J Wallace
BACKGROUND: The purpose of this study was to evaluate percutaneous transhepatic portal vein stenting (PVS) for palliation of refractory ascites and/or variceal bleeding caused by extrahepatic portomesenteric venous stenosis in patients with pancreaticobiliary cancer. MATERIALS AND METHODS: A single-institution, retrospective review of patients who underwent PVS between January 2007 and July 2015 was performed. A total of 38 patients were identified, of whom 28 met the inclusion criterion of PVS performed primarily for refractory ascites or variceal bleeding...
December 28, 2017: Oncologist
Pat Gulhati, Kanwal Raghav, Rachna Shroff, Gauri Varadhachary, Milind Javle, Wei Qiao, Huamin Wang, Jeffrey Morris, Robert Wolff, Michael J Overman
LESSONS LEARNED: Panitumumab has no clinical activity in metastatic RAS wild-type small bowel adenocarcinoma (SBA) and ampullary adenocarcinoma (AAC), possibly due to the foregut and midgut derivation of small bowel and ampulla.These results, along with findings from genomic characterization of SBA, suggest that SBA represents a unique intestinal malignancy and treatments should not be habitually extrapolated from colorectal cancer.Further studies evaluating the benefit of targeted therapies exclusively in SBA and AAC are warranted...
December 19, 2017: Oncologist
Vishal Sharma, Surinder Singh Rana, Sobur Uddin Ahmed, Sonali Guleria, Ravi Sharma, Rajesh Gupta
The peritoneum is involved in many diseases such as primary malignancy (mesothelioma), infectious disease (tuberculosis), and disseminated malignancy (peritoneal carcinomatosis). The peritoneal disease may manifest as ascites and/or peritoneal masses or nodules. Endoscopic ultrasound (EUS), due to its ability to provide high-resolution images, has revolutionized the imaging and diagnosis of pancreaticobiliary diseases among other gastrointestinal conditions. EUS can not only help in imaging of various lesions close to the gastrointestinal lumen but also aspirate/biopsy them...
November 2017: Endoscopic Ultrasound
Karen L Talia, W Glenn McCluggage
Adenocarcinoma of the cervix is less common than squamous cell carcinoma, although its relative prevalence is increasing. Oncogenic (high-risk) human papillomavirus (HPV) infection is implicated in the development of approximately 90% of all cervical adenocarcinomas. Of the remaining non-HPV associated tumours, the most frequent is gastric-type adenocarcinoma (GAS), which is recognised by the World Health Organization as a form of mucinous adenocarcinoma of the cervix. Minimal deviation adenocarcinoma (MDA) of mucinous type (adenoma malignum) is considered an extremely well differentiated variant of GAS and is encompassed within the category of GAS...
February 2018: Pathology
Takao Itoi, Todd H Baron
No abstract text is available yet for this article.
February 2018: Journal of Hepato-biliary-pancreatic Sciences
Matthew J Sullivan, Hope Kincaid, Shashin Shah, Hiral N Shah
Background and study aims:  For suspected pancreaticobiliary malignancies, endobiliary brush cytology during endoscopic retrograde cholangiopancreatography (ERCP) remains the diagnostic test of choice despite historically poor and variable sensitivity. This has led to increased use of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) as an initial test. Recently, our institution began using a cytology brush that was designed specifically to collect a more substantial and higher-quality sample...
December 2017: Endoscopy International Open
P K Wright, D A Shelton, M R Holbrook, S A Thiryayi, N Narine, D Slater, D N Rana
OBJECTIVE: To compare endoscopic ultrasound (EUS)-FNAC diagnosis of pancreatic lesions with patient outcome based upon the Papanicolaou Society of Cytopathology pancreaticobiliary terminology classification scheme diagnostic categories: Panc 1 (non-diagnostic); Panc 2 (negative for malignancy/neoplasia); Panc 3 (atypical); Panc 4B (neoplastic, benign); Panc 4O (neoplastic, other); Panc 5 (suspicious of malignancy); and Panc 6 (positive/malignant). METHODS: All EUS-FNA pancreas specimens taken at Manchester Royal Infirmary in 2015 were prospectively classified according to the above scheme at the time of cytology reporting and data recorded prospectively...
February 2018: Cytopathology: Official Journal of the British Society for Clinical Cytology
A Grieve, D Harrison, C Westgarth-Taylor, J Loveland
BACKGROUND: Choledochal malformation (CM) is a well-described and relatively rare condition. CMs may present on antenatal ultrasound screening, through childhood and into adulthood. The aetiology is not well understood but the association with a pancreaticobiliary malunion predisposes to the development of CMs. OBJECTIVES: To review the experience of CMs in the Department of Paediatric Surgery, University of the Witwatersrand, Johannesburg to improve our patient care for this population...
November 6, 2017: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Michael X Ma, Michael J Bourke
No abstract text is available yet for this article.
November 21, 2017: Gastrointestinal Endoscopy
Francis C H Wong, Eric C H Lai, Daniel T M Chung, Chung Ngai Tang
Ampullary tumours are uncommon lesions with potential risk of malignancy. The management is excision by either endoscopic ampullectomy, pancreaticoduodenectomy or transduodenal excision. Endoscopic ampullectomy offers a less invasive approach, whereas pancreaticoduodenectomy allows radical excision of the tumour. They both carry their own limitations. Transduodenal excision of ampullary tumour offers significantly lower risks with low recurrence rate, and can be offered for benign or early grade tumours. Limited cases of laparoscopic transduodenal excision of ampullary tumours were reported in the literature, probably due to the technical difficulties in performing the operation, especially during the reconstruction of the pancreaticobiliary ducts with the laparoscopic approach...
October 2017: Hepatobiliary Surgery and Nutrition
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