Complementary roles of CT and endoscopic ultrasound in evaluating a pancreatic mass.

Objective: The objectives of our study were to illustrate normal pancreatic anatomy using endoscopic ultrasound and to show the imaging findings of solid pancreatic masses on endoscopic ultrasound and CT.

Conclusion: CT and endoscopic ultrasound have complementary roles in the diagnosis of solid pancreatic masses.

Pancreatic cyst fluid DNA analysis in evaluating pancreatic cysts: a report of the PANDA study.

Background: The role of pancreatic cyst fluid DNA analysis in evaluating pancreatic cysts remains unclear.

Objective: Our purpose was to evaluate the utility of a detailed DNA analysis of pancreatic cyst fluid to diagnose mucinous and malignant cysts.

Design: Prospective, multicenter study.

EUS-guided FNA diagnosis of pancreatic endocrine tumors: new trends identified.

Background: Pancreatic endocrine tumors (PETs) are rare (1 per 100,000 population) and are thought to be functioning in up to 85% of cases and are generally less than 2 cm in size. By previous reports, 15% to 50% of PETs are nonfunctioning and are discovered either incidentally or by symptom evaluation from a mass effect. EUS-guided FNA (EUS-FNA) has been shown to accurately diagnose PETs and to localize tumors for surgical resection.

Endoscopic ultrasound compared with laparoscopy for staging esophageal cancer.

Background: Endoscopic ultrasonography (EUS) is an accurate modality for locoregional staging of esophageal cancer. Given an increasing prevalence of distal esophageal adenocarcinoma, some centers employ laparoscopic staging (LS) in addition to noninvasive staging methods. We sought to compare EUS and LS for nodal staging in patients with esophageal cancer.

EUS yield in evaluating biliary dilatation in patients with normal serum liver enzymes.

The finding of common bile duct (CBD) dilatation on abdominal imaging frequently results in additional testing. It has been our impression that endoscopic ultrasound (EUS) evaluation of a dilated CBD is a low-yield examination in the setting of normal serum liver enzymes. We therefore sought to evaluate the EUS yield in evaluating CBD dilatation in patients with normal as compared to elevated serum liver enzymes.

EUS-guided paracentesis for the diagnosis of malignant ascites.

Background: EUS and EUS-guided fine-needle aspiration (EUS-FNA) have well-defined roles in the diagnosis and staging of GI and pancreaticobiliary malignancy. Malignant ascites usually represents peritoneal carcinomatosis, increases disease stage, and portends a poor prognosis. There are limited data regarding the yield of EUS-guided paracentesis (EUS-P) for the diagnosis of malignant ascites.

Isolated pancreatic tuberculosis diagnosed by endoscopic ultrasound-guided fine needle aspiration: a case report.

Context: Pancreatic tuberculosis is an extremely rare clinical entity, despite the high prevalence of tuberculosis worldwide. The pancreas is protected from direct environmental exposure; therefore most cases of pancreatic tuberculosis arise from contiguous infection from peri-pancreatic lymph nodes or rarely from hematogenous spread. Pancreatic tuberculosis can present as a cystic or solid pancreatic mass mimicking pancreatic malignancy.

Enteral feeding without pancreatic stimulation.

Objective: All forms of commonly practiced enteral feeding techniques stimulate pancreatic secretion, and only intravenous feeding avoids it. In this study, we explored the possibility of more distal enteral infusions of tube feeds to see whether activation of the ileal brake mechanism can result in enteral feeding without pancreatic stimulation, with particular reference to trypsin, because the avoidance of trypsin stimulation may optimize enteral feeding in acute pancreatitis.

Methods: The pancreatic secretory responses to feeding were studied in 36 healthy volunteers by standard double-lumen duodenal perfusion/aspiration techniques over 6 hours.

Severe acute pancreatitis: nutritional management in the ICU.

Patients with acute pancreatitis have elevated nutritional needs due to increased energy expenditure and catabolism. It is a clinical challenge to provide adequate nutrition to these patients while maintaining gut function, preventing pancreatic stimulation, and minimizing the risk of septic and metabolic complications associated with nutritional support. We present the case of a patient who had severe acute pancreatitis and was initially given total parenteral nutrition.

Basaloid squamous cell cancer arising in Barrett's esophagus.

Basaloid squamous cell carcinoma (BSCC) is a rare form of cancer that arises primarily in the upper aerodigestive tract. Esophageal BSCC is extremely rare, accounting for less than 2% of primary esophageal malignancies. It is histopathologically distinct from squamous cell carcinoma and has an aggressive biological behavior with poor survival outcomes.

Nutritional support in acute pancreatitis.

Acute pancreatitis is one of the most catabolic of critical illnesses, and its clinical course is often prolonged. Consequently, the need for interventional nutritional support is great. Because of fears that feeding might exacerbate the tryptic autodigestion and disease process, total parenteral nutrition was used exclusively until recent years, when it was recognized that the complications of hyperglycemia and sepsis outweighed nutritional benefits.