| Reviews
Endoscopic
Ultrasound in Idiopathic Acute Pancreatitis.
Tandon M, Topazian M.
Am J Gastroenterology 2001;96:705-9 |
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EUS was performed
in patients with idiopathic acute pancreatitis.
EUS revealed a potential cause for pancreatitis
in 68% of subjects including microlithiasis, chronic
pancreatitis, pancreas divisum and pancreatic
cancer. The authors concluded that EUS is a less
invasive test than ERCP,demonstrated an etiology
for idiopathic acute pancreatitis in two-thirds
of patients and most patients did not require
an ERCP in the follow-up period.
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Detection
and tumor staging of malignancy in cystic, intraductal,
and solid tumors of the pancreas by EUS.
Brandwein SL, Farrell JJ, Centeno BA, Brugge WR.
Gastrointestinal Endoscopy 2001;53:722-7 |
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The
study included 96 patients with solid, cystic
and intraductal lesions of the pancreas. EUS-guided
FNA provided evidence of malignancy in solid,
cystic and ductal lesions with sensitivities of
59.5%, 50% and 60% respectively. EUS staging accuracy
was better for cystic lesions(100%) and solid
tumors(85%). Even though the sensitivity for EUS
guided FNA was comparable between solid, cystic
and intraductal lesions, the staging accuracy
of EUS for intraductal lesions was significantly
lower at 47%. |
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Impact
of EUS-guided fine-needle aspiration on lymph node staging
in patients with esophageal carcinoma.
Vazquez-Sequeiros E, Norton ID, Clain JE, et al.
Gastrointestinal Endoscopy 2001;53:751-7
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The
study included 74 patients with esophageal cancer
in whom the results of EUS versus EUS-FNA for
lymph node staging were compared. The authors
concluded that EUS-FNA is more sensitive and accurate
than EUS alone for preoperative staging of locoregional
and celiac lymph nodes associated with esophageal
carcinoma and this technique should be routinely
performed when treatment decisions will be affected
by the nodal stage. |
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These three articles continue to define
the role of EUS as a diagnostic test.
Tandon et al have provided data which supports
the role of EUS as a less invasive way (relative to ERCP)
to suggest an etiology for pancreatitis. In some cases, their
subjects will eventually require ERCP (microlithiasis), but
in other instances, EUS can be the definative procedure. This
is especially important for the diagnosis and staging of early
pancreatic tumors.
To that end, Brandwein et all have examined
the accuracy of EUS in evaluating potentially malignant pancreatic
lesions. Their group points out some limitations in using
EUS, but it still seems to be the most accurate method (relative
to invasiveness) overall in the current available methods
of assessing lesions of the pancreas.
Whereas Tandon, et al have shown the utility
of EUS as a less invasive test, Vasques-Sequeiros et al have
demonstrated the improved diagnostic yield of EUS when combined
with needle aspiration in nodal staging of esophageal tumors.
It is not surprising that aspiration is more accurate than
imaging alone, since nodes can enlarge for non-malignant reasons
(imaging false positives), and small nodes can contain cancer
(imaging false negatives). As with any aspiration technique,
however, a negative sample does not mean that malignancy is
not present. Still, improved accuracy should provide better
information from which one can ultimately base decisions on
the need for neoadjuvant therapy.
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