| Keywords
Varicies, MALT lymphoma, Liver tumor
Introduction
This months articles deal with the utility
of EUS as a diagnostic test to predict outcome of therapy
in benign (varicies) and malignant (Gastric MALT) conditions.
In addition, an interesting case report of a new EUS guided
therapuetic intervention is described.
Body
Catheter
US probe EUS evaluation of gastric cardia and perigastric
vascular structures to predict esophageal variceal recurrence.
Konishi Y, Nakamura T, Kida H, etal.
Gastrointestinal Endoscopy 2002;55:197-203 |
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This is a study
from Japan that assessed the risk of recurrence
of esophageal varices by evaluating the severity
of vascular structures at the cardia in patients
with portal hypertension using a catheter US probe
before endoscopic variceal ligation. Patients
with a higher grade of perforating veins by catheter
EUS had a significantly higher recurrence rate
of varices after treatment.
This study describes methodology
in which EUS is used to predict failure of endoscopic
variceal management. Although it is too early
to know if there will ultimately be any clinical
utility of this approach, it may be useful in
studies as a method to stratify patients when
comparing medical and endoscopic therapies in
the management of varicies.
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Conservative
Treatment of Primary Gastric Low-Grade B-Cell Lymphoma
Of Mucosa-Associated Lymphoid Tissue: Predictive Factors
of Response and Outcome.
Levy M, Copie-Bergman C, Traulle C, et al.
American Journal of Gastroenterology 2002;97:292-297 |
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Forty
eight patients with H. pylori and MALT(mucosa
associated lymphoid tissue)lymphoma who were treated
with anti-H.pylori therapy in this study. The
major negative predictive factor for the tumor
response to anti-H.pylori treatment was the presence
of peri-gastric lymph nodes on EUS. Remission
was acheived with anti-H.pylori treatment in 76%
of patients when no peri-gastric lymph nodes were
detected versus 33% when EUS detected lymph nodes
(p=0.025).
It can take several months to
know if antibiotics will be effective when treating
H.pylori associated gastric MALT lymphoma. Furthermore,
it is well known that antibiotics are not useful
in advanced gastric MALT lymphoma. This report
by Levy et al shows that EUS may be a mechanism
to determine who should have an antibiotic trial
or who should go directly to antineoplastic therapy.
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EUS-guided
treatment of a solid hepatic metastases.
Barclay Rl, Perez-Miranda M, Giovannini M.
Gastrointestinal Endoscopy 2002;55:266-270
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Interventional
EUS has opened up possibilities for EUS guided
therapy.
This is an interesting(and supposedly the first
published case report) of EUS guided treatment
of a solid hepatic metastasis that was treated
with ethanol injection under EUS guidance.
Ethanol injection has been shown
to have some utility in the management of certain
tumors of the liver, particularly hepatoma. In
some selected instances, it may ultimately be
preferable to use this endoscopic approach rather
than an extracorporeal appraoch. |
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Summary
These studies continue to show ways in which
EUS can be used to help manage patients. ALthough larger studies
may be needed to determine if these newer approaches can alter
outcome, the studies reviewed this month appear to have a
good chance of being applicable in the clinical management
of selected patients.
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