Endoscopic Ultrasound Staging of Gastric Lymphoma

Abstract The choice of treatment in gastric lymphoma is stage dependent. Endoscopic ultrasound (EUS) is a very accurate technique to assess T- and N-staging of primary gastric lymphoma. Two cases of high-grade gastric non-Hodgkin's lymphoma are documented with videos of upper endoscopy and EUS. The technique for an appropriate staging of the disease with EUS is demonstrated. This article is part of an expert video encyclopedia

Role of contrast harmonic-endoscopic ultrasound in pancreatic cystic lesions

none4noIncidental pancreatic cysts (PCs) are frequently encountered in the general population often in asymptomatic patients who undergo imaging tests to investigate unrelated conditions. The detection of a PC poses a significant clinical dilemma, as the differential diagnosis is quite broad ranging from benign to malignant conditions. Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) has been reported to be an accurate tool in the differential diagnosis; however, its sensitivity is suboptimal and false negative results do occur. Contrast harmonic EUS (CH-EUS) was demonstrated to be a useful tool to investigate pancreatic solid lesions to differentiate between benign and malignant ones. In the setting of PCs, CH-EUS could help identify areas of malignant growth inside the cystic cavities. Several studies have reported promising results showing malignant areas in PCs as hyperenhanced lesions. Confirmation of malignancy can then be obtained by FNA, which should be precisely targeted according to the findings of the contrast harmonic study.openSerrani, Marta; Lisotti, Andrea; Caletti, Giancarlo; Fusaroli, PietroSerrani, Marta; Lisotti, Andrea; Caletti, Giancarlo; Fusaroli, Pietr

Safe Endoscopic Removal of a Migrated Esophageal Stent Using a Protection Hood

Abstract Delayed esophageal metallic stent migration after a neo-adjuvant therapy of advanced esophageal cancer is a relatively frequent event, which is sometimes due to tumor response to chemotherapy. Stent migration in the stomach is usually asymptomatic but it can cause potentially life-threatening complications as bowel obstruction or perforation. Most gastric migrations can be managed endoscopically; however endoscopic stent removal could also be a risky procedure due to hemorrhage or esophageal perforation. This case report describes a safe and quick endoscopic method to remove a migrated esophageal metallic stent from the stomach using a protection hood mounted on the tip of the endoscope

Cancer of the Esophagus - Endoscopic Ultrasound: Selection for Cure

Several treatment options are available to treat esophageal cancer. Ideally, treatment should be individualized, based on the projected treatment outcome for that individual. Accurate staging of the extent of the disease at the time of diagnosis offers the most rational attempt at stratifying patients into categories that can be used to affect treatment choices. Endoscopic ultrasonography (EUS) is the most accurate nonoperative technique for determining the depth of tumour infiltration and thus is accurate in predicting which patients will be able to undergo complete resection. EUS is also being used for tumour staging in order to guide treatment decisions in patients with esophageal cancer

Cancer of the Esophagus - Endoscopic Ultrasound: Selection for Cure

Several treatment options are available to treat esophageal cancer. Ideally, treatment should be individualized, based on the projected treatment outcome for that individual. Accurate staging of the extent of the disease at the time of diagnosis offers the most rational attempt at stratifying patients into categories that can be used to affect treatment choices. Endoscopic ultrasonography (EUS) is the most accurate nonoperative technique for determining the depth of tumour infiltration and thus is accurate in predicting which patients will be able to undergo complete resection. EUS is also being used for tumour staging in order to guide treatment decisions in patients with esophageal cancer

Improved stool DNA integrity method for early colorectal cancer diagnosis

Background: DNA integrity analysis could represent an alternative approach to the early detection of colorectal cancer. Previously, fluorescence long DNA (FL-DNA) in stools was extracted using a manual approach and analyzed by capillary electrophoresis assay (CE FL-DNA). We aimed to improve diagnostic accuracy using a simpler and more standardized method [Real Time PCR FL-DNA (RT FL-DNA)] for the detection of early malignant lesions in a population undergoing colorectal cancer screening. Methods: From 241 stool samples,DNAwas extracted using manual and semiautomatic extraction systems and analyzed using FL-DNA tests by CE and RT assays. The RT FL-DNA approach showed slightly higher sensitivity and specificity compared with the CEFL-DNA method. Furthermore, we compared the RTFL-DNA approach with the iFOBT report. Results: Nonparametric ranking statistics were used to analyze the relationship between the median values of RT FL-DNA and the clinicohistopathologic characteristics. The median values of both variables were significantly higher in patients with cancer than in patients with noncancerous lesions. According to the Fagan nomogram results, the iFOBT and FL-DNA methods provided more accurate diagnostic information and were able to identify subgroups at varying risks of cancer. Conclusions: The combination of the semiautomatic extraction system and RT FL-DNA analysis improved the quality of DNA extracted from stool samples. Impact: RT FL-DNAshows great potential for colorectal cancer diagnosis as it is a reliable and relatively easy analysis to perform on routinely processed stool samples in combination with iFOBT

EUS-FNA for Pelvic Lesions: Is This the Final Answer?

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Is there a role for celiac plexus block for chronic pancreatitis?

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Forward-view EUS: A systematic review of diagnosticand therapeutic applications

Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) and therapeutic procedures have been performed by a curved linear array (CLA) echoendoscope since the early 1990\u2019s. This particular echoendoscope, allowing real time visualization of aspiration needles and of other devices, has substantially remained unchanged since its introduction to the market. In a context of rapidly expanding indications for EUS-guided procedures, a dedicated forward view (FV) echoendoscope has been developed and tested under different clinical conditions. The FV echoendoscope is equipped with front endoscopic and EUS view, allowing deployment of needles and other devices through the working channel in straight direction. Several new diagnostic and therapeutic applications may thereby potentially be feasible with the FV echoendoscope and the established ones may prove easier to accomplish. The published literature with the FV echoendoscope has been systematically reviewed and the results are presented analytically and discussed in detail. EUS-FNA and therapeutic procedures, including pancreatic pseudocyst drainage, treatment of gastric fundal varices, celiac plexus neurolysis, and duct drainage were reported. The FV echoendoscope showed some unique advantages, opening new possibilities such as EUS-FNA in difficult gastrointestinal tracts and combined endoscopic/EUS treatment with frontal approach. However, no statistically significant evidence of superiority of the FV echoendoscope vs. the CLA echoendoscope was found in pancreatic pseudocyst drainage. No complications specifically attributable to the use of the FV echoendoscope were reported

Palliative care in patients with liver cirrhosis: it is the time to deal with the burden

We read, with great interest, Dr Gola et al's1 manuscript entitled “Economic analysis of costs for patients with end stage liver disease over the last year of life”, in which the authors clearly demonstrated the increased economic burden of end stage liver disease (ESLD) on health systems. This original article should not be considered only a mere analysis of costs related to ESLD but also as a starting point for future directions in this field. Liver cirrhosis is the common result of different injuries to liver tissue, leading to necroinflammation and neofibrogenesis. The prognosis of patients with chronic liver disease varies widely, depending on the presence of portal hypertension, the clinical stage, the removal of the underlying pathogenetic noxa (ie, alcohol, hepatitis C virus) or the occurrence of decompensation and other clinical events (ie, infections, kidney injury). Quality of life results reduced in almost all patients with cirrhosis because of an impairment in all the three areas of health-related QoL (HRQOL), namely, physical, psychological and social; despite these evidences, the assessment of HRQOL is frequently a marginal issue in the clinical evaluation of the patient with cirrhosis. The stage of the disease, age (older), gender (female) and cultural and socioeconomic issues significantly influence patients’ QoL.