Around 30% of the gastroenteropancreatic endocrine tumors (GPET) cannot be preoperatively identified by the common diagnostic imaging techniques. The aim of this retrospective study was to present ...our experience in the diagnosis and localization of GPET by endoscopic ultrasonography (EUS) performed prior to surgery and compare this with a review of the literature.
Twenty patients suspected of having specific hormonal syndromes were correlatively explored with US, CT, MR, angiography, octreoscan and radial EUS with Olympus GFUM3/EUM3 and GF-UM20/EUM 20 and 30. Eleven cases were males (55%) and 9 (45%) females with a mean age of 60 years (range: 40-80 years). Of the 20 patients, 14 had endocrine 16 tumors in the pancreas and 6 tumors in the gastrointestinal tract. In 6 patients no tumors were found and were therefore used as a control group. Of the 20 patients, 14 underwent surgery confirming the existence of GPET in 12 cases.
The diagnostic sensitivity and precision of the EUS were of 75 and 78%, respectively, with these percentages being higher to those obtained with other imaging techniques. The specificity was 83%. All these values were slightly lower than the mean obtained on review of the literature. Two pancreatic tumors of less than or equal to 1 cm were detected which had not been previously diagnosed with US, CT and MR. In two cases the exact situation was not determined. Echo-endoscopic exploration of the pancrease could not be completely performed in two cases (10%), one pancreatic carcinoma and one double pancreatic gastrinoma which was gastrectomized. Endoscopic ultrasonography is a good preoperative technique for detecting GPET and in the evaluation of small sized tumors it may surpass other imaging techniques. The usefulness of EUS as a second exploration following US has been suggested for the diagnosis and localization prior to surgery.
Twenty-one consecutive patients with 24 possible submucosal lesions of the digestive tract were studied. Endoscopic ultrasonography (EUS) differentiated between 17 true positive submucosal tumors and ...3 true negative extrinsic compressions. False positives were interpreted in 3 cases and in one patient no lesion was echoendoscopically observed (false negative). The sensitivity was 94%, the specificity 50% and the positive and negative predictive values were 82% and 75%, respectively. In conclusion, EUS may be the method of choice for the study of submucosal tumors since it allows visualization of the five layers of the wall of the digestive tract in which a tumor may originate, determination of its sonographic features, depth and exact size, in addition to the invasion of neighboring organs. Moreover, EUS may aid in collecting material for cytology and microscopy by fine needle aspiration puncture (FNAP) by EUS.
Malignant and nonmalignant stenosis of the gastrointestinal tract are a significant diagnostic and therapeutic challenge. Malignant stenosis is difficult to stage because the endosonographic catheter ...cannot be passed through the stricture. The objective of this study was to stage tumoral stenosis using a miniprobe.
We evaluated 30 patients (20 men, 10 women, average age 65 years). There were 9 nonmalignant cases and 21 malignant cases of stenosis of the gastrointestinal tract. Of the malignant cases, two were caused by extradigestive neoformations that infiltrated the wall of the digestive tract. Twelve of the remaining 19 cases were treated by surgery (63%). Echoendoscopy was done with a miniprobe through the working channel of the videoendoscope. The TNM classification was used to diagnose extension. The pathology study was used to confirm the final diagnosis after surgery for malignant lesions. Nonmalignant stenosis was confirmed in clinical follow-up.
Sensitivity of the miniprobe in determining stage T and stage N were 83% and 64% respectively.
Miniprobes provide valuable additional information in the study of stenosis of the digestive tract. Sensitivity is good in classifying tumoral T stage, and acceptable for classifying N stage, and may be improved by using low-frequency miniprobes.
Ten patients with gastro-pancreatic apudomas were prospectively treated with SMS 201-995 at the dose of 25-50 mg/12 h. subcutaneously before breakfast and dinner during two months. The biological and ...clinical effects were evaluated, as well its possible antitumoral action. When clinical or biological benefit was ascertained, the treatment was continued uninterruptedly. SMS 201-995 was well tolerated. It allows ambulatory treatment. It reduced hormonal levels in 62% of cases and controlled symptoms in 50%. No antitumoral effects were observed in the majority of patients.
Eight patients suffering gastroenteropancreatic apudomas were prospectively treated with subcutaneous SMS 201-995 at a dose of 25-50 mg/12 hours, before breakfast and dinner during two months. ...Biological and clinical effects were evaluated as well as the possible antitumor effect. In those cases that obtained a clinical and/or biological benefit, treatment was continued uninterruptedly. The results showed that SMS 201-995 is a well tolerated drug which permits ambulatory treatment of patients with GI endocrine tumors being the main objective the reduction of hormone levels and symptom control, not finding in most cases an antitumor effect.
