IJGII Inernational Journal of Gastrointestinal Intervention

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< PreviousNext >Gastrointestinal Intervention 2014; 3(2): 65~119
  • Original Article 2014-12-30

    What is the best method for endoscopic ultrasound-guided fine needle aspiration? Needle types and aspiration techniques

    Kazuo Hara, Nobumasa Mizuno, Susumu Hijioka, Hiroshi Imaoka, Masahiro Tajika, Tsutomu Tanaka, Makoto Ishihara, Yasumasa Niwa, and Kenji Yamao

    Abstract : BackgroundMany factors such as the size and type of needle and negative pressure can affect the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). However, because many biases exist in clinical studies of humans, particularly in terms of individual differences among participants, results are largely dependent on the characteristics of the patients and tumors. The aim of this study was to evaluate the properties of EUS-FNA needles and aspiration techniques using animal and artificial models under stable conditions.MethodsWe performed EUS-FNA on a pig liver under general anesthesia in Protocol 1. We used all types (soft-type, stiff-type, and reverse-beveled needles) and all sizes of needles with negative pressure applied using a 20-mL syringe or the slow-pull technique. All the obtained specimens were fixed in formalin for the cell block method. The specimens were scored according to the our own grading system. In Protocol 2, EUS-FNA was performed using three materials: Japanese sweet bean jelly, tofu, and cow liver. The obtained specimens were placed on the dish one by one. The FNA specimens were evaluated macroscopically and compared with each other.ResultsIn Protocol 1, the mean ± standard deviation score for reverse-beveled needles (4.1 ± 1.41) was significantly higher than that for soft-type needles (3.5 ± 1.79; P < 0.05, Dunn’s test). However, there was no significant difference between stiff-type and reverse-beveled needles. The score for each size of needle showed no significant difference, even between 25 gauge (G) and 19 G. Comparing the slow-pull technique with 20-mL negative pressure, the slow-pull technique provided a small specimen but less blood in Protocol 2. Negative pressure was not useful for EUS-FNA of a hard tumor model.ConclusionThe score for the reverse-beveled needle was better than that of the soft-type needle. The slow-pull technique may be useful for a bloody tumor, but it provides less specimen. We should select the EUS-FNA method based on the relevant patient and tumor characteristics.

    Cited By: 2

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  • Case Report 2014-12-30

    Metastatic carcinoid from occult primary masquerading as Crohn’s disease

    Jacob Moremen, Cecil E. Brown, Douglas Brewer, and Heather R. Nolan

    Abstract : Carcinoid tumors are neoplasms that are seen in all portions of the gastrointestinal tract. In some instances, primary tumors can go undiagnosed or misdiagnosed owing to nonspecific presenting symptoms. In this case report we discuss a patient with vague abdominal symptoms and radiographic findings previously attributed to Crohn’s disease, who at operative exploration was found to have a metastatic carcinoid tumor. This report demonstrates the nonspecific nature of metastatic carcinoid tumor and how its presentation can masquerade as more common gastrointestinal system abnormalities.

    Cited By: 0

  • Case Report 2014-12-30

    Looking beyond lymph nodes: Beware of the lurking pseudoaneurysm!

    Ayesha Nasrullah, Jon K. Bell, Sailaja Reddy, Ray Ashleigh, and Velauthan Rudralingam

    Abstract : An arteriovenous fistula of the superior mesenteric vessels leading to pseudoaneurysm formation is rare and most commonly occurs after blunt trauma or surgery. We describe a case of a superior mesenteric artery?superior mesenteric vein (SMA/SMV) pseudoaneurysm that was initially misinterpreted as an enlarging hypervascular nodal metastasis on surveillance computed tomography (CT) in a patient who had undergone ileal carcinoid resection. When the case was discussed at the specialist multidisciplinary meeting to consider surgical resection, it was noted that the apparent “hypervascular node” on CT had a signal void character on magnetic resonance imaging, which is atypical for a lymph node. Coronal CT reformat demonstrated a vascular origin from the superior mesenteric trunk. This resulted in the correct diagnosis of a pseudoaneurysm secondary to an SMA/SMV fistula. This avoided an unnecessary repeat surgery, and the patient underwent endovascular repair. In our patient, the distal was closed by 3-mm coils and the proximal was closed by an Amplatzer plug with successful results. Hence, it is crucial for radiologists to have a systematic approach and understanding of vascular-related abnormalities to avoid misdiagnosis that can potentially lead to unwanted morbidity.

    Cited By: 0

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  • Case Report 2014-12-30

    Medulloblastoma metastatic to the pancreas: a case report

    Hemanth Gavini, Venkat D. Arukala, John Stewart, and Jeffrey H. Lee

    Abstract : We present a case of medulloblastoma metastatic to the pancreas in a 41-year-old woman with recurrent cerebellar medulloblastoma. On presentation, computed tomography of the abdomen and pelvis showed a 2.2 cm × 2.6 cm hypodense pancreatic head mass associated with obstruction of the pancreatic duct. Endosonography with fine needle aspiration (EUS-FNA) was performed. Cytology showed a malignant small cell neoplasm that was consistent with medulloblastoma and was morphologically identical to the primary cerebellar medulloblastoma. Metastatic medulloblastoma to the pancreas is an extremely rare form of a secondary pancreatic tumor and very few case reports exist in the literature. The diagnosis rests on comparing cytological features when primary and secondary tumors are both available.

    Cited By: 1

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  • Review Article 2014-12-30

    Stenting for malignant gastric outlet obstruction: Current status

    Wei Zhong Zhou, and Zheng Qiang Yang

    Abstract : Malignant gastric outlet obstruction is most commonly seen in the patients with cancers of the pancreas, gallbladder, biliary tree, stomach, and duodenum. The placement of self-expanding metal stents under fluoroscopy or endoscopy has proven to be an alternative to surgical treatment and to have the advantages of being less invasive, having a lower complication rate, and allowing a quicker recovery. In this review article, we provide an overview of current fluoroscopic and endoscopic stenting practice for gastric outlet obstruction with regard to stent design and stenting procedure, efficacy, and complications, and compare stenting and surgery.

    Cited By: 5

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  • Review Article 2014-12-30

    Small bowel intervention and application of enteroscopy for altered small bowel anatomy?endoscopic advanced therapy using double balloon enteroscopy

    Masaaki Shimatani, Norimasa Fukata, Ryo Suzuki, Sachi Miyamoto, Kota Kato, Toshiyuki Mitsuyama, Hideaki Miyoshi, Tsukasa Ikeura, Makoto Takaoka, and Kazuichi Okazaki

    Abstract : The management of patients with small bowel obstruction distal to the third part of the duodenum and altered gastrointestinal anatomy is challenging. Until recently, surgery had been the mainstay of treatment for obstruction, which had however posed a risk of serious complications. The difficulty with the endoscopic approach in the deep area of the intestine and the blind end of the altered gastrointestinal anatomy could be a possible reason. Recently, the advent of overtube-assisted endoscopy has radically facilitated endoscopic interventions such as balloon dilation for benign obstructions or placement of self-expanding metal stents for malignant obstructions. Advanced endoscopic therapy for small bowel stricture or choledochojejunal anastomotic stricture has become a safe and effective method.

    Cited By: 1

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  • Review Article 2014-12-30

    Palliative self-expandable metallic stent placement for colorectal obstruction caused by an extracolonic malignancy

    Shuntaro Yoshida, Hiroyuki Isayama, and Kazuhiko Koike

    Abstract : Endoscopic stenting with a self-expandable metallic stent (SEMS) is widely accepted for the management of malignant colorectal obstruction (MCRO). This procedure is effective for both palliative purposes and as a bridge to surgery. MCRO can arise from colorectal cancer (CRC) or advanced extracolonic malignancy (ECM), including gastric, pancreatobiliary, small bowel, endometrial gynecologic, or urinary malignancies. In patients with an ECM, the pathogenesis of obstruction is different from that of CRC and is caused by direct tumor invasion into the lumen or extrinsic compression at an advanced stage. These differences and the advanced clinical condition can influence the clinical results. Endoscopic colonic stenting for ECM has lower technical and clinical success rates than for CRC. Appropriate patient selection and technical issues are key to improved outcomes. In the near future, a prospective clinical trial should evaluate the efficacy and safety of SEMS placement for MCRO caused by ECM.

    Cited By: 4

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  • Review Article 2014-12-30

    Bariatric embolization for the treatment of obesity

    Charles Y. Kim, Ben E. Paxton, Clifford R. Weiss, and Aravind Arepally

    Abstract : Embolization of the left gastric artery with the intent of decreasing hunger, termed bariatric embolization, has experienced a recent surge of attention in the literature and at medical conferences. This endovascular treatment for obesity has demonstrated promising data as a potentially new and effective minimally invasive treatment for obesity. The goal of this review article is to discuss the background, rationale, and existing data on this new topic.

    Cited By: 1

  • Review Article 2014-12-30

    Paradigm shift away from open surgical necrosectomy toward endoscopic interventions for necrotizing pancreatitis

    Jae Hee Cho, Yoon Jae Kim, and Yeon Suk Kim

    Abstract : Interventions for infected and symptomatic walled-off pancreatic necrosis (WOPN) have undergone a paradigm shift away from open surgical necrosectomy toward endoscopic intervention such as transmural drainage and necrosectomy. Recent multicenter studies and evidence-based guidelines have suggested the safety and efficacy of endoscopic transmural necrosectomy (ETN) for management of complicated WOPN. In consideration of the inherent properties and the risks associated with this procedure, ETN should be performed by expert endoscopists who are well-versed in management of necrotizing pancreatitis and supported by a special multidisciplinary team. Although there have been limited data to define the selection criteria and the techniques regarding ETN, this comprehensive review focuses on the current indications, therapeutic outcomes, complications, and controversies of ETN for management of WOPN.

    Cited By: 5

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  • Original Article 2014-12-30

    A re-review of caspule endoscopies of patients referred for deep enteroscopy changes their management

    Meagan Gray, J. Matthew Moore, and Andrew Brock

    Abstract : BackgroundPatients are commonly referred to tertiary centers for deep enteroscopy because of abnormal findings on video capsule endoscopy (VCE). The aim of this study was to determine how often clinical management changes when VCEs are reviewed by an enteroscopist prior to scheduling a procedure.MethodsA retrospective review was performed of patients referred for deep enteroscopy because of abnormal capsule endoscopy. All VCE images were reviewed prospectively by the tertiary center’s enteroscopist. Patients were then scheduled for deep enteroscopy or other management based on the capsule review. The rate of disagreement in the capsule findings, changes in management, and the diagnostic and therapeutic yield of enteroscopy were calculated.ResultsVideo capsule endoscopy was available in 45 patients who were referred for deep enteroscopy. The mean age was 61 years (51% were females). Indications included obscure GI bleeding (37 patients), abnormal imaging (3 patients), abdominal pain (2 patients), Peutz-Jegher syndrome (2 patients), and weight loss (1 patient). Referring physician findings included polyps or masses (13 patients), angioectasia (13 patients), ulcers (9 patients), active bleeding (9 patients), nonspecific findings (8 patients), and normal (2 patients). A capsule review led to disagreement of the findings of 13 (29%) patients and led to a change in the management of 9 (20%) patients. The most common reason for a change in management was overcalled lesions. Thirty-seven patients underwent enteroscopy with a diagnostic yield of 48.8% and therapeutic intervention in 24.4%.ConclusionA review of referral VCE studies led to a change in management in a large percentage of patients, particularly when the indication was polyp, mass, or ulcer. Patients referred for deep enteroscopy should have their capsule re-read by an enteroscopist prior to scheduling the procedure.

    Cited By: 3

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April, 2024
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