Online)

ABSTRACT Context The role of EUS to evaluate subtle radiographic abnormalities of the pancreas is not well defined. Objective To assess the yield of EUS±FNA for focal or diffuse pancreatic enlargement/fullness seen on abdominal CT scan in the absence of discrete mass lesions. Design Retrospective database review. Setting Tertiary referral center. Patients and interventions Six hundred and 91 pancreatic EUS exams were reviewed. Sixty-nine met inclusion criteria of having been performed for focal enlargement or fullness of the pancreas. Known chronic pancreatitis, pancreatic calcifications, acute pancreatitis, discrete mass on imaging, pancreatic duct dilation (greater than 4 mm) and obstructive jaundice were excluded. Main outcome measurement Rate of malignancy found by EUS±FNA. Results FNA was performed in 19/69 (27.5%) with 4 new diagnoses of pancreatic adenocarcinoma, one metastatic renal cell carcinoma, one metastatic colon cancer, one chronic pancreatitis and 12 benign results. Eight patients had discrete mass lesions on EUS; two were cystic. All malignant diagnoses had a discrete solid mass on EUS. Conclusions Pancreatic enlargement/fullness is often a benign finding related to anatomic variation, but was related to malignancy in 8.7% of our patients (6/69). EUS should be strongly considered as the next step in the evaluation of patients with focal enlargement of the pancreas when clinical suspicion of malignancy exists

3506 COMPARISON OF CONTROLLED RADIAL EXPANSION BALLOON DILATORS TO CONVENTIONAL BALLOON DILATORS IN PATIENTS WITH BENIGN ESOPHAGEAL STRICTURES

BACKGROUND: The current treatment of benign esophageal strictures often relies on the use of successively larger reusable Savary dilators or disposable balloon catheters. Recently, a new balloon catheter has been designed in which the balloon material has been preprogrammed to reach three successively larger sizes, depending upon the inflation pressure. This allows one balloon to provide dilatation to three different diameters (CRETM balloon, Microvasive). AIM: To provide a prospective, multi-center, randomized comparison of the CRETM balloon to a standard balloon dilator with regards to ease of use, complications, and effectiveness in patients with benign esophageal strictures. METHODS: A total of 60 patients were studied. Forty men and 20 women, mean age of 67 (range 24-87), with benign esophageal strictures were randomized based on stricture severity. At the time of entry, the two groups were comparable with regards to age, gender, history of previous dilatation, presence of esophagitis, use of antireflux medication, severity of dysphagia, and stricture severity. The mean lumen diameter prior to dilatation was 12.3 mm in the CRETM group and the standard group was 12.7 mm. RESULTS: In comparing the effectiveness of the two groups, the dysphagia score within the first day was reduced by 3.5 in the CRETM group vs. 2.6 in the standard group, p=0.07. Maximum dilatation obtained was 17.3 mm in the CRETM group versus 17.1 mm in the standard group. Dilatation time was comparable, although the CRETM balloon deflated more quickly than the standard, 6 versus 28 seconds. A slightly smaller number of CRETM balloons were used per case than standard dilators, 1.2 versus 1.4. There was a trend in favor of the CRETM balloon in regards to effectiveness at one month with an improvement in dysphagia score of 2.8 vs. 1.9 (p=0.07). CONCLUSIONS: The CRETM balloon works at least as well as the standard balloon in dilatation of benign esophageal strictures. The CRETM balloon allows dilatation to progressively larger diameters using a single catheter. There is a trend that suggests the CRETM balloon might allow more effective dilatation with an increase in lumen size and reduction of symptoms. These trends should be explored in the context of a larger-scale randomized trial