EUS-guided photodynamic therapy with verteporfin for ablation of normal pancreatic tissue: a pilot study in a porcine model (with video).

Background: EUS-guided photodynamic therapy (PDT) with the photosensitizing agent porfimer sodium has been shown to be effective in ablation of pancreatic tissue.

Objective: The objective of this study was to determine the effectiveness and safety of EUS PDT with verteporfin, a photosensitizer associated with less photosensitivity.

Design: Prospective investigation of 6 swine that received an IV injection of 6 mg/m2 of verteporfin before EUS.

Feasibility of endoscopic transgastric distal pancreatectomy in a porcine animal model.

Background: In contrast to laparoscopic tubal ligation, oophorectomy, and appendectomy, laparoscopic distal pancreatectomy is associated with a morbidity rate of more than 50% and a mortality rate of more than 3%.

Objective: To develop a minimally invasive, transgastric endoscopic technique for distal pancreatectomy in a nonsurvival series in swine.

Design: Experimental study.

Endoscopic therapy of benign pyloric stenosis and gastric outlet obstruction.

Purpose Of Review: To examine the short and long-term success rates of balloon dilation of pyloric stenosis.

Recent Findings: Several large studies have demonstrated high rates of success for the relief of symptoms from pyloric stenosis using through-the-scope balloons. These dilating balloons readily increase the diameter of the stenotic pylorus on average from 6 to 16 mm.

Endoscopic transmural drainage of pancreatic pseudocysts: results of a national and an international survey of ASGE members.

Background: Pancreatic pseudocysts can be drained endoscopically via the transpapillary or the transmural routes. We sought to assess endoscopic methods of pseudocyst drainage.

Methods: A web-based survey was sent to American Society for Gastrointestinal Endoscopy (ASGE) members in the United States (U.

International survey of knowledge of indications for EUS.

Background: The knowledge level for EUS indications among gastroenterologists across different locations and practices is not known. The aim of this study was to assess knowledge of EUS indications among a diverse group of gastroenterologists, both nationally and internationally.

Methods: A web-based survey was designed to assess knowledge of EUS with respect to 4 organ systems: esophagus, gastroduodenum, hepatopancreatobiliary, and colorectum.

Clinical implications of the extent of invasion of T3 esophageal cancer by endoscopic ultrasound.

Background: Endoscopic ultrasound (EUS) is an accurate imaging modality for local staging of esophageal cancer. We aimed to determine if depth of tumor invasion beyond muscularis propria (MP), as determined by preoperative EUS, is predictive of tumor recurrence or survival (a positive change in mortality) in patients with T3 esophageal cancer.

Methods: Records and images of all patients with T3 N1 M0 esophageal cancer staged with EUS at our institution between January 1999 and October 2003 were reviewed.

Endoscopic ultrasound-guided trucut biopsy of the cyst wall for diagnosing cystic pancreatic tumors.

Background & Aims: Nonoperative methods for diagnosis of pancreas cysts often lack sufficient accuracy. Accurate diagnosis is needed to determine prognosis and guide clinical management. The aim of this study was to determine whether the tissue obtained by endoscopic ultrasound-guided trucut biopsy (EUS TCB) is sufficient for histologic diagnosis of cystic pancreatic tumors (CPTs).

Assessment of the impact of an educational course on knowledge of appropriate EUS indications.

Background: The knowledge level of EUS among gastroenterologists likely influences the appropriateness of requested indications for EUS. It remains unknown what the impact is of a short EUS course, involving didactic teaching, on knowledge levels of EUS indications for EUS. The aim of this study was to assess the impact of a 3-day educational course on knowledge levels of attending gastroenterologists regarding the appropriateness of indications for EUS.

EUS-guided trucut biopsy in establishing autoimmune pancreatitis as the cause of obstructive jaundice.

Background: The diagnosis of autoimmune pancreatitis can be difficult and often requires a larger specimen than can be provided by FNA alone to determine if the tissue sample obtained with EUS trucut biopsy (TCB) is sufficient to allow adequate histologic review to establish the diagnosis of autoimmune pancreatitis.

Methods: EUS TCB was performed in patients presenting with obstructive jaundice who were suspected of having autoimmune pancreatitis based on their clinical, laboratory and imaging studies. The charts were retrospectively reviewed to determine the feasibility of TCB.

EUS features of recurrent transitional cell bladder cancer metastatic to the GI tract.

Background: Recurrent transitional cell bladder cancer (TCBC) can metastasize to the GI tract albeit uncommonly. This is the first report of the EUS appearance of metastatic TCBC to the GI tract. In addition to describing the EUS features of recurrent metastatic TCBC, this study determined the number of patients referred for evaluation of a primary GI luminal cancer in which EUS instead established the diagnosis of metastatic recurrent TCBC.

Knowledge of indications for EUS among gastroenterologists and non-gastroenterologists.

Background: The level of awareness among non-gastroenterologists of the indications for EUS is unknown. This study assessed knowledge of the indications and the utility of EUS among gastroenterologists and non-gastroenterologists in a large multispecialty academic practice.

Methods: A questionnaire was designed that tested knowledge of the indications for EUS with respect to 4 organ systems: esophagus, gastroduodenum, hepatopancreatobiliary system and colorectum.

AIDS Cholangiopathy.

AIDS is an advanced disease with systemic and infectious complications that can be fatal. When a patient with AIDS presents with right upper quadrant or midepigastric pain, cholestasis, and symptoms of cholangitis, AIDS cholangiopathy should be suspected and appropriate diagnostic and therapeutic interventions should be initiated. Opportunistic infections such as Cryptosporidium and cytomegalovirus are the most common cause of AIDS cholangiopathy.

Role of endoscopic ultrasonography in diseases of the extrahepatic biliary system.

Endoscopic ultrasonography (EUS) is one of the most recent advances in gastrointestinal endoscopy. Available EUS devices include echoendoscopes, such as radial scanning and linear array echoendoscopes, and catheter ultrasound probes. Endoscopic ultrasonography has various applications, such as staging of gastrointestinal malignancy, evaluation of submucosal tumors, and has grown to be an important modality in evaluating the pancreaticobiliary system.

Intraductal administration of an NK1 receptor antagonist attenuates the inflammatory response to retrograde infusion of radiological contrast in rats: implications for the pathogenesis and prevention of ERCP-induced pancreatitis.

Introduction: The neurogenic inflammatory mediator, substance P (SP), has been implicated in the pathogenesis of acute secretagogue-induced pancreatitis. We hypothesized that it may also play an important role in the development of acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). AIMS Our aim was to evaluate the effectiveness of CP-96345, a NK1 receptor antagonist, in diminishing post-ERCP pancreatitis in a rat model.

Differentiating pancreatic cancer from pseudotumorous chronic pancreatitis.

The differentiation between pancreatic carcinoma and pseudotumorous pancreatitis continues to be a challenge. Several diagnostic imaging and endoscopic modalities can assist in making the differentiation, but the accuracy of each method varies. Radiologic imaging techniques include transabdominal ultrasound, computed tomography, magnetic resonance imaging, magnetic resonance cholangiopancreatography, and positron emission tomography.