EUS features of annular pancreas (with video).

Background: An annular pancreas is a rare congenital anomaly that results in a band of pancreatic tissue, either partially or completely encircling the duodenum.

Objectives: In patients referred for an upper-GI (UGI) EUS (1) to determine the prevalence of an annular pancreas identified by EUS versus CT and (2) to describe the EUS features of an annular pancreas.

Design: After review of UGI EUS procedures from January 1, 2000, through June 1, 2006, we conducted a retrospective review of EUS annular pancreas images to identify characteristic EUS features.

Globular amyloid deposits isolated to the small bowel: a rare association with AL amyloidosis.

We describe a 55-year-old man with isolated duodenal and jejunal amyloidosis producing rare endoscopic and histologic findings. The patient had no specific gastrointestinal complaints but underwent esophagogastroduodenoscopy and colonoscopy because of progressive microcytic anemia. Endoscopy revealed multiple polyps, some filiform and measuring up to 3 cm in length, in the duodenum and proximal jejunum.

Endoscopic retrograde cholangiopancreatography in post-Whipple patients.

Background And Study Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is an established modality for evaluation and treatment of pancreaticobiliary disorders. However, it is technically more challenging in patients with post-surgical anatomy. The success rate of ERCP in patients with prior pancreaticoduodenectomy (Whipple resection) is unknown.

Endoscopic retrograde cholangiopancreatography catheter and accessory exchange using a short hydrophilic guide wire: a prospective study.

Background And Study Aims: Although hydrophilic guide wires can be used to facilitate stricture cannulation during endoscopic retrograde cholangiopancreatography (ERCP), some endoscopists avoid using them because of concerns about wire loss during exchange. There are no data available on the outcomes of using a short hydrophilic guide wire during ERCP. The aim of this study was to assess the outcomes of therapeutic ERCP procedures in which a short, completely hydrophilic guide wire was used exclusively.

Preoperative diagnosis of extrapancreatic neural invasion in pancreatic cancer.

Background & Aims: Pancreatic cancer recurs in most patients after resection with curative intent. Recurrence is particularly common in patients with extrapancreatic neural invasion (EPNI), the presence of which correlates with poor prognosis. Macroscopic EPNI may be detected with conventional noninvasive imaging and endoscopic ultrasound (EUS) imaging, but microscopic EPNI has required postoperative pathologic examination of surgical specimens.

Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience.

Background & Aims: The Japan Pancreas Society criteria for diagnosis of autoimmune pancreatitis (AIP) mandate presence of characteristic imaging (diffuse pancreatic enlargement with diffusely irregular, narrow pancreatic duct). AIP has unique histologic features associated with infiltration of tissues of affected organs with abundant IgG4-positive cells. We propose expanded diagnostic criteria for AIP with a cohort of histologically confirmed AIP.

Neural ganglia visualized by endoscopic ultrasound.

Objectives: To describe visualization of gastrointestinal neural ganglia by endoscopic ultrasound (EUS).

Methods: We retrospectively identified patients in whom neural ganglia were visualized during EUS and the diagnosis of ganglion confirmed by EUS guided fine needle aspiration (FNA) cytology.

Results: Ten patients were identified.

A novel endoscopic approach to brachytherapy in the management of Hilar cholangiocarcinoma.

Objectives: Traditionally, biliary brachytherapy sources are placed percutaneously via transhepatic drains or endoscopically via nasobiliary tubes (NBT). Another ERCP is needed for stent replacement after NBT removal. The aim of this study was to determine the feasibility and safety of endoscopic transpapillary insertion of irradiation sources through 10-Fr stents.

Phase II, parallel-design study of preoperative combined modality therapy and the matrix metalloprotease (mmp) inhibitor prinomastat in patients with esophageal adenocarcinoma.

Purpose: This randomized phase II, parallel-design study evaluated preoperative combined modality therapy and the matrix metalloprotease (MMP) inhibitor prinomastat in patients with resectable adenocarcinoma of the esophagus that were stage II or greater. The objectives of the trial were to determine pathologic complete response rate (pCR), overall response rate, progression-free survival, pattern of disease relapse, and two-year and overall survival.

Patients And Methods: Preoperative staging included computed tomography, endoscopic ultrasound, and, when feasible, laparoscopy.

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.

Hemobilia caused by cytomegalovirus cholangiopathy.

A 57-yr-old male on long-term steroid therapy presented with hematemesis, fever, and a retroperitoneal fluid collection. Hemobilia was diagnosed, but the cause was not identified by ERCP, computed tomography, or angiography. Peroral cholangioscopy revealed multiple biliary ulcers.

EUS-guided ethanol injection of normal porcine pancreas: a pilot study.

Background: Ethanol injection is a potential means of EUS-guided pancreatic tissue ablation. The effects of injected ethanol on normal pancreas are unknown.

Methods: Transgastric ethanol injection of the body and the tail of normal porcine pancreas was performed under EUS guidance in 8 anesthetized Yorkshire pigs: 98% ethanol was injected in 4 animals, and 50% ethanol was injected in 4 animals.

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).

Outcome following endoscopic stenting of pancreatic duct strictures in chronic pancreatitis.

Goals: To assess outcomes following 6 months of endoscopic stenting for dominant pancreatic duct strictures in painful chronic pancreatitis.

Background: Pancreatic stent placement may improve pain in chronic pancreatitis. Long-term outcomes after a 6-month period of stenting are unknown.

Serum amylase, pancreatic stents, and pancreatitis after sphincter of Oddi manometry.

Background: Serum amylase levels 2 hours after ERCP predict postprocedure pancreatitis. The value of serum amylase measurements after sphincter of Oddi manometry (SOM) and the effect of pancreatic-duct stent placement on serum amylase are unknown.

Methods: Records were reviewed for 88 SOM patients who had serum amylase measured 2 hours after the procedure.

EUS diagnosis of vascular invasion in pancreatic cancer: surgical and histologic correlates.

Background: Endoscopic ultrasound (EUS) has been compared to intraoperative surgical palpation for diagnosis of vascular invasion by pancreatic cancer. This study compares EUS with vascular resection and histologic evidence of vascular invasion in resected pancreatic masses.

Methods: All patients with solid pancreatic masses who underwent both preoperative EUS and surgery at 1 hospital over a 7 year period were identified.

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.

Absence of human papillomavirus in esophageal carcinomas from southwestern Kenya.

Esophageal squamous cell cancer is highly prevalent in south-western Kenya. The role of human papillomavirus (HPV) in esophageal cancers from this region was evaluated. Biopsies of 29 esophageal squamous cell cancers were assayed for HPV DNA sequences by reverse line blot polymerase chain reaction, using 27 HPV type-specific probes.

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.

Improved outcomes for benign disease with limited pancreatic head resection.

We sought to determine whether duodenum-preserving pancreatic head resections (DPPHRs) offer improved outcomes for benign disease of the proximal pancreas. A single-cohort study was performed of 86 consecutive patients who underwent DPPHR, extended lateral pancreaticojejunostomy with excavation of the pancreatic head (ELPJ), standard or pylorus-sparing Whipple procedure (WHIP), or distal pancreatectomy (DPR). Aspects of cost, complications (mortality and morbidity), and outcomes were assessed during a follow-up period of 6-63 months (mean, 3 years).

Painful cystic duct remnant diagnosed by endoscopic ultrasound.

Postcholecystectomy pain may remain unexplained and difficult to treat. This report describes three patients with constant postcholecystectomy abdominal pain that may have arisen from the cystic duct remnant or a neuroma of the cystic duct stump. In each case pain was exacerbated by pushing on cystic duct surgical clips with an EUS-guided needle, and temporarily abolished by an EUS-guided injection of bupivicaine and triamcinolone.

Pancreatic endosonography after Billroth II gastrectomy.

Background And Study Aims: Prior Billroth II gastrectomy is considered a relative contraindication to endoscopic ultrasonography (EUS) of the pancreatic head. This study reviews experience with pancreatic EUS in such patients.

Patients And Methods: Eleven patients were identified who had previous Billroth II gastrectomy and underwent attempted pancreatic EUS.