The Role of EUS in Pancreatic Cysts

Pancreatic cystic lesions (PCLs) comprise various pathologically different groups of lesions that usually share many common clinical features. Cystic lesions and fluid collections of the pancreas often present a diagnostic and therapeutic challenge. Pancreatic cystic lesions are being diagnosed with increasing frequency owing to the widespread use of cross-sectional imaging. The differential diagnosis for cystic lesions of the pancreas is broad, and the role of endoscopic ultrasonography (EUS) is becoming more clearly defined. EUS has become an important tool in the diagnosis and risk stratification of pancreatic cysts. The ability of EUS to provide detailed imaging, tissue, and cyst fluid for analysis makes it a seemingly powerful diagnostic tool for PCLs. It can accurately visualize the cyst morphology, assess vascular pattern by contrast harmonic scan, and perform fine-needle aspiration (FNA) for evaluation of cytology and molecular markers. Furthermore, several studies have shown the therapeutic applications of endoscopic ultrasound in management of PCLs, including EUS-guided ablation of cystic pancreatic tumors by injection of alcohol, aiding in pancreatic pseudocyst drainage

Endoscopic Ultrasonography (EUS) and Gallbladder

Diseases of the gallbladder commonly manifest as cholelithiasis and gallbladder cancer. Cholelithiasis has become a significant health problem in developed societies, affecting 10–15% of the adult population. Gallbladder polyps are incidentally detected in approximately 4–7% of patients. In addition, other gallbladder problems may also occur, but these are extremely rare: remnant cystic duct, gallbladder anomalies, Mirizzi syndrome, and gallbladder parasites. Endoscopic ultrasound (EUS) is an excellent method for visualizing the bile duct and gallbladder given its proximity when imaging from the duodenum. EUS can be used for evaluation of gallbladder disease that includes investigation of suspected cholelithiasis or biliary sludge, imaging of polypoid lesions of the gallbladder, and diagnosis and staging of gallbladder cancer. This procedure can be helpful to further distinguish benign from malignant or potentially malignant gallbladder polyps and play an important role in determining the treatment strategy for gallbladder polyps. Furthermore, EUS can help in the diagnosis of rarely gallbladder diseases such as remnant cystic duct, gallbladder anomalies, Mirizzi syndrome, and gallbladder parasites. Recent studies have suggested that EUS‐guided gallbladder drainage (EUS‐GBD) can be considered to be an effective emergency treatment for acute cholecystitis patients at high risk for surgery

Risk factors of HBs Ag positive in blood donors of Hamedan, Iran

Background: Viral hepatitis B is a common community acquired infection. It damages the liver tissue and can be a risk factor for cirrhosis and liver cancer. In the present study, we investigated the major risk factors for being HBs Ag positive among blood donors of Hamedan, Iran.Methods: A cross-sectional study was carried out in Hamedan city. All of the blood donors in Blood Transfusion Organization Center of the city were asked to fill out a questionnaire between September 2011 and February 2012. Logistic regression was used to calculate Odds Ratios (OR) for risk factors of being HBs Ag positive using IBM SPSS Statistics for Windows, Version 22.0.Results: Among 571 participants 119 (20.8%) were HBs Ag positive. Of all patients, 158 (27.6%) were female, 506 (88.6%) were living in urban areas. Also, 375 (65.7%) were married. Among the potential risk factors of HBs Ag positivity studied, “History of Surgery” ranked first (OR=3.11 P=0.003) and “Familial History of Liver Disease” was the second significant risk factor (OR=2.90 P=0.013). Human bite, dental filling, and needle stick had odds ratios less than one. However, they were not found to be statistically significant (P>0.05).Conclusion: Of all risk factors investigated in the present study, “History of Surgery” suggests a risk of infection transmission through surgical team. More studies on different populations are needed due to regional characteristics of hepatitis transmission

characteristic Findings of primary sclerosing cholangitis on endoscopic Retrograde cholangiography: Which is the Most common Finding?

Abstract Background: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease and one of the most common indications for cholangiography (ERCP). We undertook this study to clarify whether there is a specific pattern of involvement of the biliary tract in patients with PSC and to evaluate features of PSC disease on ERCP in order to be able to manage this disease better. Methods: This retrospective study included 45 patients admitted to Taleghani Hospital in 2004–2010 and diagnosed to have PSC on the basis of typical cholangiographic findings in combination with clinical and laboratory data. Patients suspected to have secondary sclerosing cholangitis were excluded. Demographic and clinical data were recorded, along with cholangiographic findings and the frequency of large duct and small duct PSC. Results: Forty-five patients of mean age 34.8 (range 15–66) years were included. Twenty-nine patients (64.4%) had inflammatory bowel disease, and the frequency of large duct PSC and small duct PSC was 93.4% and 6.6%, respectively. The intrahepatic ducts alone were involved in 11 (24.4%) patients and the extrahepatic ducts were involved in 14 (31.1%), with 17 (37.7%) patients having both intrahepatic and extrahepatic PSC. Three (6.6%) patients did not have bile duct involvement on ERCP, and their disease was diagnosed by liver biopsy as small duct PSC. The most common type of cholangiographic feature of intrahepatic duct involvement was type 2, found in 15 (33.3%) patients, with type 3 being the most common type of extrahepatic duct involvement and detected in 16 (35.5%) patients. Conclusion: Our study demonstrates that the most common PSC finding on ERCP is involvement of both the extrahepatic and intrahepatic bile ducts, with small duct PSC being less common than large duct PSC

Cholangiocarcinoma in Magnetic Resonance Cholangiopancreatography and Fascioliasis in Endoscopic Ultrasonography

Fascioliasis is a worldwide zoonotic infection with Fasciola hepatica and Fasciola gigantica. The zoonoses are particularly endemic in sheep-raising countries and are also endemic in Iran. Typical symptoms that may be associated with fascioliasis can be divided by phases of the disease, including the acute or liver phase, the chronic or biliary phase, and ectopic or pharyngeal fascioliasis. Cholestatic symptoms may be absent, and in some cases diagnosis and treatment may be preceded by a long period of abdominal pain, eosinophilia and vague gastrointestinal symptoms. We report a case with epigastric and upper quadrant abdominal pain for the last 4 years, with imaging suggesting cholangiocarcinoma. Considering a new concept of endoscopic ultrasonography, at last F. hepatica was extracted with endoscopic retrograde cholangiography