19 research outputs found
Confocal endomicroscopy for evaluation of pancreatic cystic lesions: a systematic review and international Delphi consensus report
Background and study aims The aim of thi systematic review and consensus report is to standardize the practice of
endoscopic ultrasound (EUS-guided needle-based confocal
laser endomicroscopy (nCLE) for pancreatic cystic lesion
(PCL) evaluation.
Methods We performed an international, systematic, evidence-based review of the applications, outcomes, procedural processes, indications, training, and credentialing of
EUS-nCLE in management of PCLs. Based on available clinical evidence, preliminary nCLE consensus statements
(nCLE-CS) were developed by an international panel of 15
experts in pancreatic diseases. These statements were
then voted and edited by using a modified Delphi approach.
An a priori threshold of 80 % agreement was used to establish consensus for each statement.
Results Sixteen nCLE-CS were discussed. Thirteen (81 %)
nCLE-CS reached consensus addressing indications (noncommunication PCL meeting criteria for EUS-FNA or with
prior non-diagnostic EUS-FNA), diagnostic outcomes (improved accuracy for mucinous PCLs and serous cystadeno mas with substantial interobserver agreement of image
patterns), low incidence of adverse events (fluoresceinassociated and pancreatitis), procedural processes (nCLE
duration, manipulation of needle with probe), and training
(physician knowledge and competence).
Conclusion Based on a high level of agreement pertaining
to expert consensus statements, this report standardizes
the practice of EUS-nCLE. EUS-nCLE should be systematically considered when EUS-FNA is indicated for PCL evaluation
Moderate and severe postendoscopic retrograde cholangiopancreatography pancreatitis despite prophylactic pancreatic stent placement: The effect of early prophylactic pancreatic stent dislodgement
BACKGROUND: Placement of prophylactic pancreatic stents (PPS) is a method proven to reduce the rate and severity of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in high-risk patients; however, PPS do not eliminate the risk completely. Early PPS dislodgement may occur prematurely and contribute to more frequent or severe PEP
Increasing incidence of colorectal cancer in Asia: Implications for screening
Many Asian countries, including China, Japan, South Korea, and Singapore, have experienced an increase of two to four times in the incidence of colorectal cancer during the past few decades. The rising trend in incidence and mortality from colorectal cancer is more striking in affluent than in poorer societies and differs substantially among ethnic groups. Although changes in dietary habits and lifestyle are believed to be the reasons underlying the increase, the interaction between these factors and genetic characteristics of the Asian populations might also have a pivotal role. Non-polypoidal (flat or depressed) lesions and colorectal neoplasms arising without preceding adenoma (de novo cancers) seem to be more common in Asian than in other populations. The absence of polypoid growth preceding malignancy has posed difficulties in screening for early colorectal cancer by radiological imaging or even endoscopic techniques. Although epidemiological data are scanty, most Asian populations are not aware of the growing problem of colorectal cancer. More work is needed to elucidate the magnitude of the problem in Asia.link_to_subscribed_fulltex