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Per oral cholangiopancreatoscopy in pancreatico biliary diseases- Expert consensus statements

World Journal of Gastroenterology 2015年第15期21卷 4722-4734页

作者： Mohan Ramchandani Duvvur Nageshwar Reddy sundeep lakhtakia Manu Tandan Amit Maydeo Thoguluva Seshadri Chandrashekhar Ajay Kumar Randhir Sud Rungsun Rerknimitr Dadang Makmun Christopher Khor Asian Institute of Gastroenterology Baldota Institute of Digestive Sciences Gastro-enterology and Endocrinology MedIndia Hospitals Department of Gastroenterology Apollo Hospital Delhi Department of Gastro-enterology Medanta Gastroenterology and Hepatology King Chulalongkorn Memorial Hospital Department of Medicine Cipto Mangunkusumo Hospital Department of Internal Medicine Faculty of Medicine National University Hospital Department of Gastroenterology and Hepatology

AIM: To provide consensus statements on the use of per-oral cholangiopancreatoscopy(POCPS).METHODS: A workgroup of experts in endoscopic retrograde cholangiopancreatography(ERCP), endosonography, and POCPS generated consensus statements summarizing the utility of POCPS in pancreaticobiliary disease. Recommendation grades used validated evidence ratings of publications from an extensive literature ***: Six consensus statements were generated:(1) POCPS is now an important additional tool during ERCP;(2) in patients with indeterminate biliary strictures, POCS and POCS-guided targeted biopsy are useful for establishing a definitive diagnosis;(3) POCS and POCS-guided lithotripsy are recommended for treatment of difficult common bile duct stones when standard techniques fail;(4) in patients with main duct intraductal papillary mucinous neoplasms(IPMN) POPS may be used to assess extent of tumor to assist surgicalresection;(5) in difficult pancreatic ductal stones,POPS-guided lithotripsy may be useful in fragmentation and extraction of stones; and(6) additional indications for POCPS include selective guidewire placement,unexplained hemobilia, assessing intraductal biliary ablation therapy, and extracting migrated stents. CONCLUSION: POCPS is important in association with ERCP, particularly for diagnosis of indeterminate biliary strictures and for intra-ductal lithotripsy when other techniques failed, and may be useful for preoperative assessment of extent of main duct IPMN, for extraction of difficult pancreatic stones, and for unusua indications involving selective guidewire placement,assessing unexplained hemobilia or intraductal biliary ablation therapy, and extracting migrated stents.

关键词： Per oral cholangiopancreatoscopy Intraductallithotripsy Indeterninate biliary strictures Cholangioscopy Pancreatoscopy

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Endoscopic ultrasound guided radiofrequency ablation,for pancreatic cystic neoplasms and neuroendocrine tumors

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World Journal of Gastrointestinal Surgery 2015年第4期7卷 52-59页

作者： Madhava Pai Nagy Habib Hakan Senturk sundeep lakhtakia Nageshwar Reddy Vito R Cicinnati Iyad Kaba Susanne Beckebaum Panagiotis Drymousis Michel Kahaleh William Brugge HPB Unit Hammersmith HospitalImperial College Emcision Limited Department of Gastroenterology Bezmi Alem University Asian Institute of Gastroenterology Department of Transplant Medicine University Hospital Münster Division of Gastroenterology and Hepatology Department of MedicineWeill Cornell Medical College Massachusetts General Hospital Harvard Medical School

AIM: To outline the feasibility, safety, adverse events and early results of endoscopic ultrasound(EUS)-radiofrequency ablation(RFA) in pancreatic neoplasms using a novel probe. METHODS: This is a multi-center, pilot safety feasibility study. The intervention described was radiofrequency ablation(RF) which was applied with an innovative monopolar RF probe(1.2 mm Habib EUS-RFA catheter) placed through a 19 or 22 gauge fine needle aspiration(FNA) needle once FNA was performed in patients with a tumor in the head of the pancreas. The HabibTM EUSRFA is a 1 Fr wire(0.33 mm, 0.013") with a working length of 190 cm, which can be inserted through the biopsy channel of an echoendoscope. RF power is applied to the electrode at the end of the wire to coagulate tissue in the liver and ***: Eight patients [median age of 65(range 27-82) years; 7 female and 1 male] were recruited in a prospective multicenter trial. Six had a pancreatic cysticneoplasm(four a mucinous cyst, one had intraductal papillary mucinous neoplasm and one a microcystic adenoma) and two had a neuroendocrine tumors(NET) in the head of pancreas. The mean size of the cystic neoplasm and NET were 36.5 mm(SD ± 17.9 mm) and 27.5 mm(SD ± 17.7 mm) respectively. The EUSRFA was successfully completed in all cases. Among the 6 patients with a cystic neoplasm, post procedure imaging in 3-6 mo showed complete resolution of the cysts in 2 cases, whilst in three more there was a 48.4% reduction [mean pre RF 38.8 mm(SD ± 21.7 mm) vs mean post RF 20 mm(SD ± 17.1 mm)] in size. In regards to the NET patients, there was a change in vascularity and central necrosis after EUS-RFA. No major complications were observed within 48 h of the procedure. Two patients had mild abdominal pain that resolved within 3 d. CONCLUSION: EUS-RFA of pancreatic neoplasms with a novel monopolar RF probe was well tolerated in all cases. Our preliminary data suggest that the procedure is straightforward and safe. The response ranged from com

关键词： Endoscopic ultrasound Radiofrequencyablation Pancreas Cystic neoplasms Neuroendocrinetumors

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Role of endoscopic ultrasound in the characterization of solid pseudopapillary neoplasm of the pancreas

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World Journal of Gastrointestinal Endoscopy 2023年第4期15卷 273-284页

作者： Katarzyna M Pawlak Nadeem Tehami Ben Maher Shujaath Asif Krishn Kant Rawal Daniel Vasile Balaban Mohammed Tag-Adeen Fahd Ghalim Wael A Abbas Elsayed Ghoneem Khaled Ragab Mahmoud El-Ansary Shanil Kadir Sunil Amin Keith Siau Anna Wiechowska-Kozlowska Klaus Mönkemüller Dalia Abdelfatah Abeer Abdellatef sundeep lakhtakia Hussein Hassan Okasha Endoscopy Unit Department of GastroenterologyHospital of The Ministry of Interior and AdministrationSzczecin 01-218Poland Interventional Endoscopy Unit University Hospital Southampton NHS Foundation Trust3AX POUnited Kingdom Consultant Gastroenterologist AIG HospitalsHyderabad 500032India Department of Gastroenterology Prime Institute of Digestive SciencesRajkot 360001India Department of Gastroenterology Central Military Emergency University HospitalCarol Davila University of Medicine and PharmacyBucharest 010011Romania Division of Gastroenterology and Hepatology Department of Internal MedicineQena Faculty of MedicineSouth Valley UniversityQena 83511Egypt Department of Endoscopy Shefa Al-Orman HospitalLuxor 85951Egypt Interventional Endoscopy Unit Sainte Marie HospitalOSNY 95520France Department of Internal Medicine Gastroenterology UnitFaculty of MedicineAssuit UniversityAssuit 71511Egypt Department of Gastroenterology and Hepatology Faculty of MedicineMansoura UniversityMansoura 35511Egypt Department of Hepatology and Gastroenterology Theodor Bilharz Research InstituteGiza 12511Egypt Department of Hepatology&Gastroenterology Theodor Bilharz Research InstituteGiza 12511Egypt Department of Gastroenterology Liaquat National Hospital&Medical CollegeKarachi 75900Pakistan

BACKGROUND Solid pseudopapillary neoplasm(SPN)is an uncommon pathology of the pancreas with unpredictable malignant *** ultrasound(EUS)assessment plays a vital role in lesion characterization and confirmation of the tissue ***,there is a paucity of data regarding the imaging assessment of these *** To determine the characteristic EUS features of SPN and define its role in preoperative *** This was an international,multicenter,retrospective,observational study of prospective cohorts from 7 large hepatopancreaticobiliary *** cases with postoperative histology of SPN were included in the *** collected included clinical,biochemical,histological and EUS *** One hundred and six patients with the diagnosis of SPN were *** mean age was 26 years(range 9 to 70 years),with female predominance(89.6%).The most frequent clinical presentation was abdominal pain(80/106;75.5%).The mean diameter of the lesion was 53.7 mm(range 15 to 130 mm),with the slight predominant location in the head of the pancreas(44/106;41.5%).The majority of lesions presented with solid imaging features(59/106;55.7%)although 33.0%(35/106)had mixed solid/cystic characteristics and 11.3%(12/106)had cystic *** was observed in only 4(3.8%)*** pancreatic duct dilation was uncommon,evident in only 2 cases(1.9%),whilst common bile duct dilation was observed in 5(11.3%)*** patient demonstrated a double duct sign at *** and Doppler evaluation demonstrated inconsistent appearances with no emergence of a predictable *** guided biopsy was performed using three different types of needles:Fine needle aspiration(67/106;63.2%),fine needle biopsy(37/106;34.9%),and Sonar Trucut(2/106;1.9%).The diagnosis was conclusive in 103(97.2%)***-seven patients were treated surgically(91.5%)and the post-surgical SPN diagnosis was confirmed in all *** the 2-year

关键词： Solid pseudopapillary neoplasm SPN Frantz tumor Endoscopic ultrasound features EUSguided biopsy Fine needle aspiration/biopsy

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