Diagnosis Of Pancreatobiliary Diseases Research Articles

Endoscopic Ultrasonography in Pediatric Patients with Pancreatobiliary Disease: Single-Center Trial.

PurposeThe use of Endoscopic ultrasonography (EUS) in pediatric patients is not as common as in adults. The aim of this study is to evaluate the role of EUS in the diagnosis of pancreatobiliary disease in childhood.MethodsBetween December 2016 and January 2018, the findings of patients who underwent EUS were evaluated retrospectively.ResultsOf the 41 patients included in the study 25 were girls (61.0%), mean age was 12.2±4.2 years. EUS was performed for biliary colic in 21 (51.2%), for recurrent pancreatitis in 12 (29.2%), for cholecystitis/cholangitis in 5 (12.2%), and for acute pancreatitis in 3 (7.4%) patients. EUS had a significant clinical effect in the decision of treatment and follow-up of 6/21 biliary colic cases, in diagnosis and follow-up of 6/12 recurrent pancreatitis cases, in decision-making and monitoring of invasive procedures (ERCP/surgery) of 3/5 acute cholecystitis/cholangitis and 2/3 of acute pancreatitis cases as well as in follow-up of the other cases. The effectiveness of EUS in determining direct treatment and invasive intervention was 43.9%. None of the patients had complications related to the EUS procedure.ConclusionAlthough current guidelines show that EUS can be used in pediatric patients, this is limited to a few published studies. In this study, it is shown that EUS is a safe method for the diagnosis, follow-up and treatment of common pancreatobiliary pathologies in childhood.

Use of simulator for EUS training in the diagnosis of pancreatobiliary diseases.

Background and Objectives:EUS has been widely used in the diagnosis of pancreatobiliary diseases. However, improvements in the conventional training pattern of EUS are needed urgently. In this study, we compared the results achieved after use of clinical practice training patterns combined with or without simulator training and evaluated the effectiveness of simulator use in EUS training.Subjects and Methods:The trainees were randomly divided into two groups: the experimental group was trained with both clinical practice and simulator training system and the control group was only trained through clinical practice. After 1 month of training, trainees of both groups were tested with an established technical evaluation procedure that aimed to assess trainees’ ability to examine the normal anatomical structure. Then, trainees in the experimental group completed a questionnaire.Results:The mean test score of the experimental group (64.53 ± 4.91) was significantly greater than that of the control group (60.09 ± 5.49; P = 0.028). Moreover, the individual test score of trainees in the experimental group was positively correlated with the frequency of simulator use (P = 0.242).Conclusion:Simulator training can promote trainees’ ability to evaluate the normal anatomical structure, and thus, can improve the efficiency of the EUS training program.

Contrast-enhanced endoscopic ultrasonography for diagnosis of pancreatobiliary diseases.

Contrast-enhanced endoscopic ultrasonography for diagnosis of pancreatobiliary diseases.

Endoscopic retrograde pancreatography: When should we do it?

Endoscopic retrograde pancreatography (ERP) is an accurate imaging modality in the diagnosis of pancreatobiliary diseases. However, its use has been substantially reduced due to the invasiveness of procedure, the risk of complications and the widespread availability of non-invasive cross-section imaging techniques (computed tomography, magnetic resonance imaging, and endoscopic ultrasound). Since the introduction of endoscopic sphincterotomy, ERP has transformed from diagnostic method to an almost exclusively therapeutic procedure. Pancreatic duct injection substantially increased the risk of post-ERP pancreatitis (1.6%-15.7%); therefore, according to international guidelines ERP is recommended only in cases where biliary intervention is required. However, the role of ERP in the management of pancreatic diseases is currently not clearly defined, but in some cases the filling of pancreatic duct may provide essential information complementing the results of non-invasive imaging techniques. The aim of this publication is to systematically summarize the literature dealing with the diagnostic yield of ERP. We would like to define the precise indications of ERP and overview a diagnostic protocol of pancreatic diseases depending on international guidelines and the opinion of Hungarian experts, because it may improve the diagnostic accuracy, minimize of burden of patients and reduce the risk of procedure related complications.

Porównanie użyteczności cholangiopankreatografii metodą rezonansu magnetycznego i endoskopowej cholangiopankreatografii wstecznej w diagnostyce chorób dróg żółciowych i trzustki

Porównanie użyteczności cholangiopankreatografii metodą rezonansu magnetycznego i endoskopowej cholangiopankreatografii wstecznej w diagnostyce chorób dróg żółciowych i trzustki

Interventional endoscopic ultrasonography

Endoscopic ultrasonography (EUS) is the combination of endoscopy and intraluminal ultrasonography. This allows use of a high frequency transducer, which, due to the short distance to the target lesion, enables ultrasonographic images of high resolution to be obtained. Endoscopic ultrasonography is now a widely accepted modality for the diagnosis of pancreatobiliary diseases. It can be used to determine the depth of invasion of gastrointestinal malignancies, and often for visualizing lesions more precisely than other imaging modalities. The most important early limitation of EUS was the lack of specificity in the differentiation between benign and malignant changes. In 1992, EUS-guided fine needle aspiration (EUS-FNA) of lesions in the pancreas head has been made possible using a curved linear array echoendoscope. Since then, many researchers have expanded the indication of EUS-FNA to various kinds of lesions and also for a variety of therapeutic purposes. In this review, we particularly focus on the present and future roles of interventional EUS, including EUS-FNA and therapeutic EUS.

Dissociation in the Sensitivity of Magnetic Resonance Cholangiopancreatography in the Diagnosis of Biliary and Pancreatic Diseases

Purpose: Magnetic resonance cholangiopanreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) are the two currently available important tools in the diagnosis of pancreatobiliary diseases. The aim of this study was to examine the sensitivity of MRCP in the diagnosis of pancreatobiliary diseases using ERCP as the gold standard. Methods: We studied all patients who had ERCP and also MRCP at Emory University Hospital from January 1st 2002 to January 20th 2007. Those who had MRCP beyond 3 months of ERCP, who had liver transplant or biliary surgery between those two tests, and who had incomplete or suboptimal ERCP or MRCP were excluded from the study. We compared the diagnosis suggested by those two tests in eligible patients. Results: 184 patients met the enrollment criteria during the study period. Of those, 136 had abnormalities mainly in the biliary system, and 48 had abnormalities mainly in the pancreas in ERCP. In the 136 patients who had biliary abnormalities, MRCP had the correct diagnosis as ERCP in 111 patients (82% of 136) and incorrect diagnosis in 25 patients (18% of 136). In contrast, in the 48 patients who had pancreatic abnormalities, MRCP had the correct diagnosis as ERCP in 46 patients (96% of 37) and incorrect diagnosis in 2 patients (4% of 48). The dissociation of the sensitivity of MRCP in diagnosis of the biliary diseases and the pancreatic diseases is statistically significant (P < 0.05). Conclusion: In this retrospective study, MRCP had more accuracy in the diagnosis of pancreatic diseases than that of biliary diseases when ERCP was used as the gold standard.

Comparison of Endoscopic Ultrasonography and Magnetic Resonance Cholangiopancreatography in the Diagnosis of Pancreatobiliary Diseases: A Prospective Study

To compare the diagnostic value of endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) in: (a) patients with a dilated biliary tree unexplained by ultrasonography (US) (group 1), and (b) the diagnosis of choledocholithiasis in patients with nondilated biliary tree (group 2). Patients were prospectively evaluated with EUS and MRCP. The gold standard used was surgery or EUS-FNA and ERCP, intraoperative cholangiography, or follow-up when EUS and/or MRCP disclosed or precluded malignancy, respectively. Likelihood ratios (LR) and pretest and post-test probabilities for the diagnosis of malignancy and choledocholithiasis were calculated. A total of 159 patients met one of the inclusion criteria but 24 of them were excluded for different reasons. Thus, 135 patients constitute the study population. The most frequent diagnosis was choledocholithiasis (49% in group 1 and 42% in group 2, P= 0.380) and malignancy was more frequent in group 1 (35%vs 7%, respectively, P < 0.001). When EUS and MRCP diagnosed malignancy, its prevalence in our series (35%) increased up to 98% and 96%, respectively, whereas it decreased to 0% and 2.6% when EUS and MRCP precluded this diagnosis. In patients in group 2, when EUS and MRCP made a positive diagnosis of choledocholithiasis, its prevalence (42%) increased up to 78% and 92%, respectively, whereas it decreased to 6% and 9% when any pathologic finding was ruled out. EUS and MRCP are extremely useful in diagnosing or excluding malignancy and choledocholithiasis in patients with dilated and nondilated biliary tree. Therefore, they are critical in the approach to the management of these patients.

1037: Usefulness of contrast-enhanced EUS and EUS elastography in the diagnosis of pancreato-biliary diseases

Trans-abdominal ultrasonography (US) is usually positioned as the first-choice diagnostic procedure in the diagnosis of pancreato-biliary diseases from the low invasiveness in Japan. However, due to the unfavorable effect of air and diet residue in digestive tract intervening between the surface of the body and the targeted organs, the observation of the whole pancreato-biliary system is not always easy. On the other hand, endoscopic ultrasonography (EUS) can make satisfactory observation of pancreato-biliary system, because effect of obstacles stated above is not necessary to be taken into account as for EUS that observation of pancreato-biliary system is possible from digestive tract lumen.

MRCP Vs ERCP: A Comparative Study in Diagnosis of Common Bile Duct Stones

Background: Because it is a noninvasive method, without complications, the magnetic resonance cholangiography (MRCP) is going to reliably replace ERCP in the diagnosis of pancreato-biliary diseases. Although many studies documented a high sensitivity and specificity of MRCP, its ability in detecting microlithiasis (< 5 mm in diameter) of common bile duct (CBD), responsible for acute biliary pancreatitis, is still controversial. Aim: to evaluate sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV) and negative predictive value (NPV) of MRCP in diagnosis of choledocolithiasis using ERCP + endoscopic sphincterotomy (ES) as the gold standard. Patients and methods: 123 individuals, suspected for lithiasis of CBD were prospectively enrolled in the study. Clinical findings were: jaundice, fever, abdominal and/or biliary pain, weight loss with altered cholestatic enzymes (ALP > 270; Î3-GT > 50 UI/l). Patients underwent upper abdominal ultrasonography (US), then MRCP and, within 72 h, diagnostic and/or operative ERCP. All patients signed an informed consent. The statistical analysis was based on the report of true positives and negatives, false positives and negatives. Results:106/123 patients completed the study. MRCP diagnosed lithiasis of CBD in 73; did not document stones in 33. ERCP confirmed the presence of lithiasis in 66/73 pts who were submitted to ES. Seven were not found to have stones after ES. Among 33 negative pts, ERCP documented stones in 9: in 4 only after ES (it was performed according to clinico-biochemical data and to CBD dilation, though ERCP did not identify stones). The stones were 2-3 mm. In 24/33 patients negative at MRCP, ERCP confirmed this response:10/24 were submitted to ES. ES was not performed in 14/24 subjects, without CBD dilation and/or cholestasis. After a 27.8 months follow-up (range: 4-54), 8/14 remained asymptomatic, 6 underwent laparoscopic cholecystectomy without finding of CBD stones at the intra-operative cholangiography. The sensitivity, specificity, diagnostic accuracy, PPV and NPV of MRCP were: 88%, 77%, 85%, 90%, 73%. Conclusions: as MRCP has still a limitation in the diagnosis of small stones, missed at US, it leaves unrisolved the question of which patient is candidate to ERCP/ES. The recognition of microlithiasis should refer to other imaging techniques preliminar to ERCP (e.g. EUS) though their limited availability makes until now MRCP a method of choice in the diagnosis of biliary disease.

Safety and Efficacy of Endoscopic Sphincterotomy and Bile Duct Clearance in Patients with Acute Cholangitis Due to the Common Bile Duct Stones

Safety and Efficacy of Endoscopic Sphincterotomy and Bile Duct Clearance in Patients with Acute Cholangitis Due to the Common Bile Duct Stones Neven Ljubicic, Luka Rotkvic Background: It has been shown that urgent endoscopic drainage is an effective treatment for acute cholangitis and is superior to surgical drainage with a better clinical outcome Because of the risk of post-sphincterotomy bleeding in these patients many endoscopists have advocated endoscopic drainage by using nasobiliary catheter or an indwelling stent without sphincterotomy. The aim of this study was to analyze safety and efficacy of endoscopic sphincterotomy (ES) and urgent stone extraction in patients with acute cholangitis due to the common bile duct stones.Methods: Between January andDecember 2002, one hundred and eleven patients with clinical jaundice and common bile duct stones were enrolled to an ES and urgent stone extraction. ES has been performed in a standard manner, always using the guide-wire. In patients with cholangitis vigorous washing of the common bile duct has been performed after removal of the stones. Forty-six patients fulfilled criteria for acute cholangitis. Prior to the ES all patients received intravenously ciprofloxacin for at least 24 hours. Results: ES has been performed successfully in 102 (92%) patients. Complete duct clearance has been achieved in 90% of patients without cholangitis and in 93% of patients with cholangitis (not significant). Complications occurred in 12% of patients without and in 16% of those with acute cholangitis (Table). In patients with post-sphincterotomy bleeding blood transfusion was not required. The median lengths of time for resolution of jaundice in patients with and without cholangitis were similar. Significant coagulopathy has been observed in two (4.5%) patients with acute cholangitis. In those patients there were no bleeding occurred after ES. Conclusions: ES and bile duct clearance is very effective and safe method even in the patients with acute cholangitis. Mild bleeding was the most common postsphincterotomy complication not required blood transfusion even in the presence of coagulopathy. *T1500 MRCP Vs ERCP: A Comparative Study in Diagnosis of Common Bile Duct Stones Luigi T. Familiari Background: Because it is a noninvasive method, without complications, the magnetic resonance cholangiography (MRCP) is going to reliably replace ERCP in the diagnosis of pancreato-biliary diseases. Althoughmany studies documented a high sensitivity and specificity of MRCP, its ability in detecting microlithiasis ( 270; I-GT > 50 UI/l). Patients underwent upper abdominal ultrasonography (US), thenMRCP and, within 72 h, diagnostic and/or operative ERCP. All patients signed an informed consent. The statistical analysis was based on the report of true positives and negatives, false positives and negatives. Results:106/123 patients completed the study. MRCP diagnosed lithiasis of CBD in 73; did not document stones in 33. ERCP confirmed the presence of lithiasis in 66/73 pts who were submitted to ES. Seven were not found to have stones after ES.Among 33 negative pts, ERCPdocumented stones in 9: in 4 only after ES (it was performed according to clinico-biochemical data and to CBD dilation, though ERCP did not identify stones). The stones were 2-3 mm. In 24/33 patients negative at MRCP, ERCP confirmed this response:10/24 were submitted to ES. ES was not performed in 14/24 subjects, without CBD dilation and/or cholestasis. After a 27.8 months follow-up (range: 4-54), 8/14 remained asymptomatic, 6 underwent laparoscopic cholecystectomy without finding of CBD stones at the intra-operative cholangiography. The sensitivity, specificity, diagnostic accuracy, PPV and NPV of MRCP were: 88%, 77%, 85%, 90%, 73%. Conclusions: asMRCPhas still a limitation in the diagnosis of small stones,missed at US, it leaves unrisolved the question of which patient is candidate to ERCP/ES. The recognition of microlithiasis should refer to other imaging techniques preliminar to ERCP (e.g. EUS) though their limited availability makes until now MRCP a method of choice in the diagnosis of biliary disease.

Endoscopic Ultrasonography with a Linear-Type Echoendoscope in the Evaluation of 94 Patients with Pancreatobiliary Disease

The purpose of this study was to evaluate a new endoscopic ultrasonography (EUS) device using a curved-array transducer with a 120-degree sagittal scan angle in the diagnosis of pancreatobiliary disease. From October 1991 to June 1993, 94 patients underwent EUS to assess radiologically detected anomalies (62 cases), tumors of the papilla of Vater (seven cases) and laboratory findings demonstrating cholestasis of unexplained origin (25 cases). In 41 cases, surgery was performed after EUS, and in 40 cases ERCP was also performed. The EUS diagnosis of chronic calcifying pancreatitis was confirmed by ERCP in 14 of 18 patients. In 30 cases, EUS detected a pancreatic tumor. In 26 of these patients, surgery was performed, confirming EUS findings regarding tumor size, portal, mesenteric, and splenic invasion, and lymph-node involvement in 20 of 25 pancreatic carcinomas (80%). In five of seven patients in whom EUS detected ampullary carcinoma, cephalic duodenopancreatectomy was performed, and the histology of the surgical specimen confirmed the diagnosis in all five. In 25 patients presenting with cholestasis of unexplained origin, EUS provided the diagnosis in 22 cases (88%). EUS using a curved-array transducer appears to be an effective diagnostic method for pancreatobiliary lesions. These results should be further evaluated in a larger series of patients.