Browsing by Subject "EUS"

Now showing 1 - 6 of 6
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    Endoscopic Ultrasound Guided Treatment of Peristomal Varices
    (Elsevier, 2023) Sarkis, Yara; Masuoka, Howard; Ghabril, Marwan; Gutta, Aditya; Al-Haddad, Mohammad A.; DeWitt, John M.; Medicine, School of Medicine
    Background and aims The use of endoscopic ultrasound (EUS) for peristomal varices (PV) is limited to case reports. Methods Patients who underwent EUS-guided treatment of PV with cyanoacrylate (CYA) and/or coils between 04/2013 and 12/2019 were identified. All had failed previous therapies or had comorbidities precluding other options. Endoscopic technique, adverse events (AEs), rebleeding and repeat interventions were assessed. Results 20 patients (12 male, median: 62 years (IQR, 54.8-69.5) underwent initial EUS PV injection of CYA for secondary (n=19) or primary prophylaxis (n=1). Within 30 days, AEs occurred in 11 (55%) and 8 were mild. During a median 2.5 months (IQR, 2-8.5) follow-up, confirmed (n=6) or suspected (n=2) PV bleeding recurred; five of 8 recurrences were retreated with CYA and/or coils without AEs. After retreatment, PV bleeding recurred in two a median 6 months (IQR, 6-30) later. Conclusion EUS appears to be a safe and promising technique for treatment of PV.
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    Endoscopic Ultrasound-Guided Therapeutic Thoracentesis
    (Editorial Office of Gut and Liver, 2013-05) Luz, Leticia P.; El Hajj, Ihab I.; DeWitt, John M.
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    Endoscopic ultrasound-guided transesophageal thoracentesis
    (Thieme, 2008-12) DeWitt, J.; Kongkam, P.; Attasaranya, S.; LeBlanc, J. K.; Sherman, S.; Sheski, F. D.
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    EUS-derived criteria for distinguishing benign from malignant metastatic solid hepatic masses
    (Elsevier, 2015-05) Fujii-Lau, Larissa L.; Abu Dayyeh, Barham K.; Bruno, Marco J.; Chang, Kenneth J.; DeWitt, John M.; Fockens, Paul; Forcione, David; Napoleon, Bertrand; Palazzo, Laurent; Topazian, Mark D.; Wiersema, Maurits J.; Chak, Amitabh; Clain, Jonathan E.; Faigel, Douglas O.; Gleeson, Ferga C.; Hawes, Robert; Iyer, Prasad G.; Rajan, Elizabeth; Stevens, Tyler; Wallace, Michael B.; Wang, Kenneth K.; Levy, Michael J.; Medicine, School of Medicine
    Background Detection of hepatic metastases during EUS is an important component of tumor staging. Objective To describe our experience with EUS-guided FNA (EUS-FNA) of solid hepatic masses and derive and validate criteria to help distinguish between benign and malignant hepatic masses. Design Retrospective study, survey. Setting Single, tertiary-care referral center. Patients Medical records were reviewed for all patients undergoing EUS-FNA of solid hepatic masses over a 12-year period. Interventions EUS-FNA of solid hepatic masses. Main Outcome Measurements Masses were deemed benign or malignant according to predetermined criteria. EUS images from 200 patients were used to create derivation and validation cohorts of 100 cases each, matched by cytopathologic diagnosis. Ten expert endosonographers blindly rated 15 initial endosonographic features of each of the 100 images in the derivation cohort. These data were used to derive an EUS scoring system that was then validated by using the validation cohort by the expert endosonographer with the highest diagnostic accuracy. Results A total of 332 patients underwent EUS-FNA of a hepatic mass. Interobserver agreement regarding the initial endosonographic features among the expert endosonographers was fair to moderate, with a mean diagnostic accuracy of 73% (standard deviation 5.6). A scoring system incorporating 7 EUS features was developed to distinguish benign from malignant hepatic masses by using the derivation cohort with an area under the receiver operating curve (AUC) of 0.92; when applied to the validation cohort, performance was similar (AUC 0.86). The combined positive predictive value of both cohorts was 88%. Limitations Single center, retrospective, only one expert endosonographer deriving and validating the EUS criteria. Conclusion An EUS scoring system was developed that helps distinguish benign from malignant hepatic masses. Further study is required to determine the impact of these EUS criteria among endosonographers of all experience.
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    Fluid analysis prior to surgical resection of suspected mucinous pancreatic cysts. A single centre experience
    (AME Publishing Company, 2011-12) Al-Rashdan, Abdullah; Schmidt, C. Max; Al-Haddad, Mohammad; McHenry, Lee; LeBlanc, Julia Kim; Sherman, Stuart; Dewitt, John
    Objective EUS-FNA cytology and fluid analysis are frequently utilized to evaluate pancreatic cysts. Elevated cyst fluid CEA is usually indicative of a mucinous pancreatic cyst but whether CEA or amylase values can subclassify various mucinous cysts is unknown. The purpose of this study is to determine whether cyst fluid CEA and amylase obtained by EUS-FNA can differentiate between mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs). Methods Using our prospective hospital EUS and surgical databases, we identified all patients who underwent EUS of a pancreatic cyst prior to surgical resection, in the last 10 years. Cysts were pathologically sub-classified as MCNs or IPMNs; all other cysts were considered non-mucinous. Values of cyst fluid CEA and amylase were correlated to corresponding surgical histopathology and compared between the two groups. Results 134 patients underwent surgery for pancreatic cysts including 82 (63%) that also had preoperative EUS. EUS-FNA was performed in 61/82 (74%) and cyst fluid analysis in 35/61 (57%) including CEA and amylase in 35 and 33 patients, respectively. Histopathology in these 35 cysts demonstrated nonmucinous cysts in 10 and mucinous cysts in 25 including: MCNs (n=9) and IPMNs (n=16). Cyst fluid CEA (p=0.19) and amylase (p=0.64) between all IPMNs and MCNs were similar. Between branched duct IPMNs and MCNs alone, cyst fluid CEA (p=0.34) and amylase (p=0.92) were also similar. Conclusion In this single center study, pancreatic cyst fluid amylase and CEA levels appeared to be of limited value to influence the differential of mucinous pancreatic cysts. Larger studies are recommended to evaluate this role further.
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    Performance characteristics of EUS for locoregional evaluation of ampullary lesions
    (Elsevier, 2015-02) Ridtitid, Wiriyaporn; Schmidt, Suzette E.; Al-Haddad, Mohammad A.; LeBlanc, Julia; DeWitt, John M.; McHenry, Lee; Fogel, Evan L.; Watkins, James L.; Lehman, Glen A.; Sherman, Stuart; Cote, Gregory A.; Medicine, School of Medicine
    Background The accuracy of EUS in the locoregional assessment of ampullary lesions is unclear. Objectives To compare EUS with ERCP and surgical pathology for the evaluation of intraductal extension and local staging of ampullary lesions. Design Retrospective cohort study. Setting Tertiary-care referral center. Patients All patients who underwent EUS primarily for the evaluation of an ampullary lesion between 1998 and 2012. Intervention EUS. Main Outcome Measurements Comparison of EUS sensitivity/specificity for intraductal and local extension with ERCP and surgical pathology by using the area under the receiver-operating characteristic (AUROC) curves and outcomes of the subgroup referred for endoscopic papillectomy. Results We identified 119 patients who underwent EUS for an ampullary lesion, of whom 99 (83%) had an adenoma or adenocarcinoma. Compared with ERCP (n = 90), the sensitivity/specificity of EUS for any intraductal extension was 56%/97% (AUROC = 0.77; 95% confidence interval [CI], 0.64-0.89). However, when using surgical pathology as the reference (n = 102), the sensitivity/specificity of EUS (80%/93%; AUROC = 0.87; 95% CI, 0.76-0.97) and ERCP (83%/93%; AUROC = 0.88; 95% CI, 0.77-0.99) were comparable. The overall accuracy of EUS for local staging was 90%. Of 58 patients referred for endoscopic papillectomy, complete resection was achieved in 53 (91%); in those having intraductal extension by EUS or ERCP, complete resection was achieved in 4 of 5 (80%) and 4 of 7 (57%), respectively. Limitation Retrospective design. Conclusions EUS and ERCP perform similarly in evaluating intraductal extension of ampullary adenomas. Additionally, EUS is accurate in T-staging ampullary adenocarcinomas. Future prospective studies should evaluate whether EUS can identify characteristics of ampullary lesions that appropriately direct patients to endoscopic or surgical resection. (Gastrointest Endosc 2015;81:380-8.)