Abstract : Background: This study aimed to identify the clinical and endoscopic factors that determined the diagnostic performance of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for mass lesions in the pancreatic head. Methods: A total of 78 consecutive patients with suspected mass lesions in the pancreatic head detected by contrast-enhanced multi-detector-row computed tomography and/or magnetic resonance imaging, who underwent EUS-FNA for cytologic and/or histologic confirmation in our institution between June 2012 and April 2017 were enrolled in the current study. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of EUS-FNA for mass lesions in the pancreatic head in our series was 61/69 (88.4%), 9/9 (100.0%), 61/61 (100.0%), 9/17 (52.9%), and 70/78 (89.7%), respectively. In univariate analyses, the clinical and endoscopic factors for determining the diagnostic performance of EUS-FNA were the echoendoscope position during needle puncture (long vs. short scope position) and the distance from the echoendoscope to the mass lesion (< 1 cm vs. ≥ 1 cm). In the multivariate logistic regression analysis, the echoendoscope position during needle puncture was the only independent and significant determining factor for the diagnostic performance of EUS-FNA for mass lesions in the pancreatic head. Conclusion: The echoendoscope position during needle puncture is a determining factor for the diagnostic performance of EUS-FNA for mass lesions in the pancreatic head.
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Abstract : Background: Transarterial chemoembolization (TACE) is reserved for the treatment of intermediate hepatocellular carcinoma (HCC) (Barcelona Clinic Liver Cancer stage B); however, it can also be utilized as a neoadjuvant treatment prior to surgical resection in resectable HCC cases. This study aimed to clarify the benefits of TACE in patients with resectable HCC. Methods: Data were retrospectively collected from patients with resectable HCC who had undergone hepatectomy between January 2010 and December 2015. A 1:1 propensity-matched case-control study was conducted using a logistic regression model that included the following covariates: sex, age, Model for end-stage liver disease score, and the number and size of tumors. Results: Of 160 patients, 37 and 123 were included in the TACE before liver resection (TACE-LR) and upfront LR groups, respectively. After 1:1 propensity score matching in the LR-matched group (n = 37), no significant differences in baseline parameters were found between the TACE-LR and LR-matched groups. Moreover, there were no significant differences in short-term outcomes, including intraoperative blood loss (800 mL vs. 500 mL, P = 0.148), operative time (300 min vs. 290 min, P = 0.824), and overall morbidity (24.3% vs. 13.51%, P = 0.235) between the TACE-LR and LR-matched groups. As long-term outcomes, no significant between-group differences were found in the 5-year disease-free survival rate (TACE-LR, 38%; LR, 58%; P = 0.89) or the 5-year overall survival rate (TACE-LR, 80.9%; LR, 80.8%; P = 0.72). Conclusion: The short- and long-term outcomes were not significantly different between preoperative TACE and LR for resectable HCC.
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Abstract : Background: This study aimed to identify clinico-radiologic predictors factors for malignant transformation reflecting disease progression (PD) mainly defined by an interval increase in cyst size and alterations in morphology, in branch duct intraductal papillary mucinous neoplasm (BD-IPMN) patients with relatively long-term follow-up. Methods: This study analyzed 135 patients with BD-IPMN enrolled from July 2005 to October 2015, in whom a communication between the cystic lesion and the pancreatic duct was confirmed by endoscopic ultrasonography, magnetic resonance cholangiopancreatography, or endoscopic retrograde cholangiopancreatography. Results: During a mean ± standard deviation follow-up period of 59.4 ± 29.2 months, PD was observed in 28 of 135 (20.7%) BD-IPMN patients. Eight patients (5.9%) displayed malignant transformation. In a univariate analysis, tumor location in the head and uncinate process, septate/multilocular cyst morphology, baseline cyst size ≥ 30 mm, an interval increase in cyst size, baseline cyst wall thickening ≥ 2 mm, baseline presence of mural nodules, and concomitant cancer at another site were significant predictive factors for malignant transformation in BD-IPMN patients. Cox forward stepwise linear regression revealed that a mural nodule (odds ratio [OR] = 58.210; 95% confidence interval [CI], 6.649–509.594; P < 0.01) and concomitant cancer at another site (OR = 8.463; 95% CI, 1.745–41.039; P < 0.01) were significant and independent predictors of malignant transformation in BD-IPMN patients. Conclusion: A considerable proportion of patients with BD-IPMN showed PD and malignant transformation during long-term follow-up. A mural nodule and concomitant cancer at another site were significant and independent predictive factors of malignant transformation in patients with BD-IPMN.
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Abstract : Background: Cold snare polypectomy (CSP) is an established technique for resecting small colorectal polyps without electrical current. This study aimed to compare the clinical effectiveness of thin-wire mini-snares and thick-wire mini-snares during CSP for small colorectal polyps. Methods: We prospectively enrolled 120 patients with colon polyps (5–8 mm in diameter) who underwent CSP between July and December 2017. Patients were randomly divided into two groups (thick-snare and thin-snare) according to the thickness of the snares. The complete resection rate (CRR), polyp characteristics, technical factors, and histopathologic features of resected specimens were carefully analysed. Results: In total, 137 eligible polyps were successfully resected using CSP (thin-snare group: n = 66, thick-snare group: n = 71). The location, size, morphology, and histologic findings of the polyps did not show statistically significant differences between the two groups. The CRR (thin-snare: 77.3% vs. thick-snare: 84.5%, P = 0.068), retrieval rate (100% in both groups), and the rates of tissue fly-away (P = 0.069), containing submucosal tissue (7.6% vs. 9.9%, P = 0.637), and intraprocedural or delayed polypectomy bleeding were not significantly different between the two groups. The CRR was significantly lower in sessile serrated lesions than in adenomas (odds ratio, 0.1; 95% confidence interval, 0.12–0.57; P = 0.010). Conclusion: In conclusion, when performing CSP for small polyps, the snare thickness does not seem to have a significant effect on the clinical outcomes, including CRR and the occurrence of complications.
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Abstract : Diaphragm disease (DD) is a rare condition that is associated with the use of nonsteroidal anti-inflammatory drugs. It is characterized by multiple diaphragm-like septa that cause a narrowing of the small bowel lumen. The diagnosis of this disorder can be challenging due to its rarity and its non-specific symptoms, which often suggest other, more probable diseases. We report the case of a 16-year-old boy who presented with iron-deficiency anemia that did not respond to iron supplementation. Despite undergoing endoscopy and computed tomography (CT) enterography, the cause of his condition could not be identified. Capsule endoscopy was attempted, but due to technical difficulties, images could not be obtained. Two years later, the patient's symptoms persisted, prompting further investigation. CT enterography revealed a foreign body in the distal ileum, which was identified as the previously administered capsule. Diagnostic laparoscopy with intraoperative endoscopy was performed to retrieve the capsule. This procedure also revealed multiple short-segment strictures causing luminal narrowing and ulcerations. These were confirmed by histopathology to be lesions associated with DD.
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Abstract : Owing to heavy blood flow originating from the portal vein and the technical difficulties associated with hemostatic procedures, duodenal varix is associated with high mortality and a poor prognosis. Percutaneous transvenous obliteration (PTO) has been used effectively to treat duodenal varices by providing direct control of duodenal variceal bleeding. This report describes a patient who experienced duodenal variceal bleeding that was successfully managed by PTO using a micro-balloon catheter, which can occlude the proximal afferent vein of the duodenal varix. Moreover, this technique can offer a more effective injection of n-butyl cyanoacrylate by blocking the inflow and preventing any reflux associated with duodenal variceal bleeding.
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Abstract : Establishing access across a post-liver transplant anastomotic obstruction is paramount to allow future management with serial dilatation and to avoid surgical interventions. Several techniques have been reported to facilitate crossing complete anastomotic obstructions. Here, we report a case of successful off-label use of a vascular re-entry device to cross a complete anastomotic obstruction in a child after failed antegrade and retrograde attempts.
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