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Endoscopic ultrasound elastography for malignant pancreatic masses and associated lymph nodes:Critical evaluation of strain ratio cutoff value

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World Journal of Gastrointestinal Endoscopy 2022年第9期14卷 524-535页

作者： Miguel Puga-Tejada Raquel Del Valle Roberto Oleas Maria Egas-Izquierdo Martha Arevalo-Mora Jorge Baquerizo-Burgos jesenia ospina Miguel Soria-Alcivar Hannah Pitanga-Lukashok Carlos Robles-Medranda Endoscopy Division Instituto Ecuatoriano de Enfermedades DigestivasGuayaquil 090505GuayasEcuador Universidad de Guayaquil Guayaquil 090505GuayasEcuador

BACKGROUND Endoscopic ultrasound(EUS)can detect small lesions throughout the digestive tract;however,it remains challenging to accurately identify malignancies with this approach.EUS elastography measures tissue hardness,by which malignant and nonmalignant pancreatic masses(PMs)and lymph nodes(LNs)can be differentiated.However,there is currently little information regarding the strain ratio(SR)cutoff in Hispanic populations.AIM To determine the diagnostic accuracy of EUS elastography for PMs and LNs with an SR cutoff value in Hispanics.METHODS A retrospective study of patients who underwent EUS elastography for PMs between December 2013 and December 2014.A qualitative(analysis of color maps)and quantitative(SR)analysis of PMs and their associated LNs was performed.The accuracy of EUS elastography in identifying malignant PMs and LNs and cutoff value for SR were analyzed.A PM and/or its associated LNs were considered malignant based on histopathological findings from fine-needle aspiration biopsy samples.RESULTS A sample of 121 patients was included,45.4%of whom were female.69(57.0%)PMs were histologically malignant,with a median SR of 50.4 vs 33.0 for malignant vs nonmalignant masses(P21.5 yielded a sensitivity of 94.2%,while a cutoff value of>121 yielded a specificity of 96.2.2%.There were significant differences in the Giovannini scores,a previously established elastic score system,between the patients grouped by their final histology results(P14.0 and>155 yielded a sensitivity of 90.9%and a specificity of 95.2%,respectively,in detecting malignancy.CONCLUSION EUS elastography is a helpful technique for the diagnosis of solid PMs and their associated LNs.The proposed SR cutoff values have a high sensiti

关键词： Ultrasound Elastography Pancreas Lymph nodes Neoplasm

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Clinical impact of confocal laser endomicroscopy in the management of gastrointestinal lesions with an uncertain diagnosis

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World Journal of Gastrointestinal Endoscopy 2017年第8期9卷 389-395页

作者： Carlos Robles-Medranda Maria Vargas jesenia ospina Miguel Puga-Tejada Manuel Valero Miguel Soria Gladys Bravo Carlos Robles-Jara Hannah Pitanga Lukashok Gastroenterology and Endoscopy Division Instituto Ecuatoriano de Enfermedades DigestivasUniversity Hospital OMNIGuayaquil 090505Ecuador

AIM To evaluate the clinical impact of confocal laser endomicroscopy(CLE) in the diagnosis and management of patients with an uncertain diagnosis.METHODS A retrospective chart review was performed.Patients who underwent CLE between November 2013 and October 2015 and exhibited a poor correlation between endoscopic and histological findings were included.Baseline characteristics,indications,previous diagnostic studies,findings at the time of CLE,clinical management and histological results were analyzed.Interventions based on CLE findings were also analyzed.We compared the diagnostic accuracy of CLE and target biopsies of surgical specimens.RESULTS A total of 144 patients were included.Of these,51%(74/144) were female.The mean age was 51 years old.In all,41/144(28.4%) lesions were neoplastic(13 bile duct,10 gastric,8 esophageal,6 colonic,1 duodenal,1 rectal,1 ampulloma and 1 pancreatic).The sensitivity,specificity,positive predictive value,negative predictive value,and observed agreement when CLE was used to detect N-lesions were 85.37%,87.38%,72.92%,93.75% and 86.81%,respectively.Cohen's Kappa was 69.20%,thus indicating good agreement.Changes in management were observed in 54% of the cases.CONCLUSION CLE is a new diagnostic tool that has a significant clinical impact on the diagnosis and treatment of patients with uncertain diagnosis.

关键词：共焦的激光 endomicroscopy 在 vivo 显微镜学小型帽子食管胃肠的癌症胰腺的包囊胆汁的苛评

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Cost-effectiveness of endoscopic ultrasound-guided coils plus cyanoacrylate injection compared to endoscopic cyanoacrylate injection in the management of gastric varices

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World Journal of Gastrointestinal Endoscopy 2021年第1期13卷 13-23页

作者： Carlos Robles-Medranda Joao Autran Nebel Miguel Puga-Tejada Roberto Oleas Jorge Baquerizo-Burgos jesenia ospina-Arboleda Manuel Valero Hannah Pitanga-Lukashok Gastroenterology and Endoscopy Division Instituto Ecuatoriano de Enfermedades DigestivasGuayaquil 090505GuayasEcuador

BACKGROUND Cyanoacrylate(CYA)injection can be performed using a standard upper endoscopy technique or under endoscopic ultrasound(EUS)guidance alone or in combination with coils.There is little information available on the economic impact of these treatment methods.AIM To compare the cost-effectiveness of treating gastric varices by CYA injection via upper endoscopy vs coils plus CYA guided by EUS.METHODS This was an observational,descriptive,and retrospective study.Patients were allocated into two groups:A CYA group and coils plus CYA group.The baseline characteristics were compared,and a cost analysis was performed.RESULTS Overall,36 patients were included(19 in the CYA group and 17 in the coils+CYA group).All patients in the CYA group had acute bleeding.They underwent a higher mean number of procedures(1.47 vs 1,P=0.025),and the mean volume of glue used was 2.15 vs 1.65 mL,P=0.133.The coils+CYA group showed a higher technical success rate(100%vs 84.2%),with a complication rate similar to the CYA group.The majority of CYA patients required hospitalization,and although the mean total per procedure cost was lower(United States$1350.29 vs United States$2978),the mean total treatment cost was significantly different(United States$11060.89 for CYA vs United States$3007.13 for coils+CYA,P=0.03).CONCLUSION The use of EUS-guided coils plus cyanoacrylate is more cost-effective than cyanoacrylate injection when the total costs are evaluated.Larger,randomized trials are needed to validate the cost-effectiveness of the EUS-guided approach to treat gastric varices.

关键词： Cost-effectiveness Endoscopic ultrasound-guided therapy Gastric varices Gastrointestinal bleeding Hemostasis Therapy

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