Abstract Background and objectives Mucinous cystic neoplasms and intraductal papillary mucinous tumours have greater malignant potential than serous cystic neoplasms. EUS alone is inadequate for ...characterising these lesions but the addition of FNA may significantly improve diagnostic accuracy. The performance of EUS-FNA is highly variable in published studies. Aim To determine the diagnostic accuracy of EUS-FNA to differentiate mucinous versus non-mucinous cystic lesions with cyst fluid analysis for cytology and carcinoembryonic antigen (CEA) by performing a meta-analysis of published studies. Methods Relevant studies were identified via structured database search and included if they used a reference standard of definitive surgical histology or clinical follow-up of at least 6 months. Data from selected studies were pooled to give summary sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio and Receiver Operating Characteristic (ROC) curve. Pre-defined subgroup analysis was performed. Results Eighteen studies (published 2002–2011) were included, with a total of 1438 patients. For cytology, pooled sensitivity was 54(95%CI 49–59)% and specificity 93(90–95)%. The diagnostic odds ratio (DOR) was 13.3 (4.37–49.43), with I2 of 77.1%. For CEA sensitivity was 63(59–67)% and specificity 88(83–91)%. The DOR was 10.76(6.29–18.41) with an I2 of 25.4%. The diagnostic accuracy of EUS-FNA was enhanced in prospective studies and studies of <36 months duration. No impact of publication bias on our results was demonstrated. Conclusions Fine-needle aspiration has moderate sensitivity but high specificity for mucinous lesions. EUS-FNA, when used in conjunction with cross sectional imaging, is a useful diagnostic tool for the correct identification of mucinous cysts.
To evaluate the safety and efficacy of percutaneous biliary stone clearance in a single hepatopancreaticobiliary (HPB) centre.
All patients who underwent percutaneous biliary stone clearance between ...2010 and 2020 at a HPB centre were identified from the radiology information system. Their demographic data, presentation, previous surgery, number/size of biliary calculi, success and complications were collected from patient records. Unpaired student's t-test was used to compare numerical variables and the Chi-square test was used to compare categorical data.
Sixty-eight patients aged between 58.5–91.1 years underwent the procedure, and 42.6% (29/68) had the procedure due to surgically altered anatomy precluding endoscopic retrograde cholangiopancreatography (ERCP). The most common presentation was cholangitis (62%). The success rate of percutaneous stone clearance was 92.7%. The average number of calculi was two (range 1–12). Of the patients included, 4.4% developed pancreatitis, 4.4% developed cholangitis, and 1.5% had hepatic artery branch pseudoaneurysm successfully treated with transarterial embolisation. There was no significant difference in success or complication rates between the different access sites (right lobe, left lobe, roux-loop, T-tube, p=0.7767).
Percutaneous biliary stone clearance is safe and effective and will continue to play an important role where ERCP fails or is impossible due surgically altered anatomy.
•Biliary calculi can be effectively treated percutaneously when ERCP is not possible.•The technique plays an important role in patients with surgically altered GI anatomy.•Percutaneous cholangioscopy & lithotripsy may facilitate treatment of larger calculi.
Background: Endoscopic balloon dilatation (EBD) of the sphincter of Oddi has been proposed as an alternative therapy with possible advantages, as compared with endoscopic sphincterotomy (ES), for ...removal of bile duct stones. Patients and methods: In a randomised study, we compared the efficacy and complication rate of the two techniques in 202 patients with common bile duct stones. Patients were followed up for 12 months. Results: A total of 103 patients were randomised to the EBD group and 99 to the ES group. Overall duct clearance was 87.1% and did not differ between the two groups (EBD 87.4%; ES 86.9%). The complication rate at 24 hours was 6.8% in the EBD group and 3.0% in the ES group (NS). Complications during follow up were 11.7% and 15.2% respectively (NS). A multivariate logistic regression analysis showed only the size of the largest stone to be predictive of success for either technique. Conclusion: Endoscopic balloon dilatation offers no significant advantage over the well established technique of endoscopic sphincterotomy for the removal of bile duct stones.
Gastric variceal bleeding is a serious complication of portal hypertension. The optimum endoscopic treatment of bleeding gastric varices is yet to be defined. We evaluated the use of Beriplast, which ...is a solution of fibrinogen and thrombin, in controlling gastric variceal bleeding.
Fifteen patients presenting with gastric variceal bleeding were entered into an open trial of endoscopic gastric intravariceal injection treatment with Beriplast (fibrin sealant) and followed for up to 1 month after endoscopic treatment.
There was failure to control bleeding in one patient. Four patients had rebleeding after the index bleed. All four were reinjected with Beriplast, and the bleeding was controlled in three. All patients were followed for 30 days, and the 30-day mortality following injection treatment was one. Fourteen patients were discharged from the hospital after the first episode of gastric variceal bleeding. None of the patients had injection-induced complications.
These results show that Beriplast is a safe and simple endoscopic treatment option and is very effective in controlling gastric variceal bleeding.
Summary
Background : The primary therapeutic goals in patients with gastroduodenal obstruction secondary to advanced malignancy are the re‐introduction of an enteral diet and early discharge. The ...endoscopic placement of expandable metal stents has been proposed as an alternative technique for palliation in patients not suitable for surgery.
Aim : To review our experience with gastroduodenal metal stent insertion for the palliation of malignant gastric and duodenal obstruction.
Methods : A retrospective review was conducted of the notes of all patients who underwent gastroduodenal stent insertion in our unit.
Results : Forty patients (mean age, 64.5 years; range, 34–93 years) underwent insertion of an enteral stent for malignant gastroduodenal obstruction. The primary tumour was gastric in 20 patients, pancreatico‐biliary in 15 and metastatic in five. A stent was successfully placed in all cases. Thirty‐two patients have subsequently died, the median (range) survival being 7 weeks (1 week to 10 months). Thirty‐three patients (82.5%) were discharged from hospital. During follow‐up, 12 patients (30%) returned to a solid diet, 20 (50%) required a soft diet, six (15%) tolerated liquids and two (5%) were unable to tolerate any enteral nutrition.
Conclusion : The use of enteral stents achieves good palliation, allowing discharge from hospital and re‐introduction of an enteral diet.
PDF
