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M Wiersema

Publications and source records attributed to M Wiersema.

6 recordsLinked to original sources
PubMed1999

Role of EUS in the preoperative staging of pancreatic cancer: a large single-center experience.

BACKGROUND: Current methods for staging pancreatic cancer can be inaccurate, invasive, and expensive. Endoscopic ultrasound (EUS) is reported to be highly accurate for local staging of gastrointestinal tumors including pancreatic cancer. The aim of this study was to assess the utility of EUS and CT for staging pancreatic cancer by comparing staging accuracies in surgical patients and evaluating the potential impact of EUS staging and training. METHODS: This was a preoperative comparison of the diagnostic operating characteristics of these procedures in a referral-based academic medical center. Data were collected on 151 consecutive patients referred with confirmed pancreatic cancer between April 1990 and November 1996. All patients had preoperative CT and EUS performed for staging. In patients undergoing surgery, the surgical staging and/or findings were used to confirm EUS and CT staging. RESULTS: Eighty-one (60%) of 151 patients underwent surgery and made up the study subset. In these 81 patients, surgical exploration provided a final T staging in 93% (75 of 81), N staging in 88% (71 of 81) and data on vascular invasion in 93% (75 of 81). In the surgical patient group, with surgical correlation, EUS accuracy for T staging was as follows: T1 92%, T2 85%, T3 93%, and for N staging was: N0 72%, and N1 72%. CT accuracy for T staging was as follows: T1 65%, T2 67%, T3 38%, and for N staging was as follows: N0 52% and N1 100%. CT failed to detect a mass in 26% of patients with a confirmed tumor at surgery. Overall accuracy for T and N staging was 85% and 72% for EUS and 30% and 55% for CT, respectively. The ability to accurately predict vascular invasion was 93% for EUS and 62% for CT (p < 0.001). EUS was 93% accurate for predicting local resectability versus 60% for CT (p < 0.001). Last, the data were divided into two groups for the senior endosonographer's experience: procedures performed between 1990 and 1992 (98 cases) and 1993 and 1994 (53 cases). This analysis revealed that 7 of 9 instances of mis-staging (78%) occurred in the earlier group, during the learning phase for EUS. CONCLUSIONS: EUS is more accurate than CT for staging pancreatic malignancies, including predicting vascular invasion and local resectability. EUS staging was significantly better than CT for T1, T2, and T3 tumors. EUS staging accuracy improved after 100 cases, thus suggesting a correlation between the accuracy of EUS staging and the number of procedures performed.

Adult↗
PubMed1999

Prospective determination of distal colon findings in average-risk patients with proximal colon cancer.

BACKGROUND: Recent guidelines indicate that colonoscopy and sigmoidoscopy are both acceptable options for screening average-risk patients for colorectal cancer. Retrospective studies have found that a majority of patients with cancer proximal to the splenic flexure have a normal screening flexible sigmoidoscopy. METHODS: This was a multicenter, prospective description of colonoscopic findings and family history in consecutive patients with proximal colon cancer. RESULTS: Among 116 prospectively identified average-risk patients with cancer proximal to the splenic flexure, 40 (34.5%) had neoplasia distal to the splenic flexure. The prevalence of patients with adenomas greater than or equal to 1 cm, with only one tubular adenoma less than 1 cm, and with only hyperplastic polyps were 16.4%, 8.6%, and 6.9%, respectively. CONCLUSIONS: Most average-risk patients with cancer proximal to the splenic flexure will have a normal screening flexible sigmoidoscopy. These patients have an unexpectedly high prevalence of large distal adenomas, but the prevalence of both single small tubular adenomas and hyperplastic polyps alone is similar to that expected during screening of the general population. Clinicians and payers should continue to seek methods to improve the cost-effectiveness and availability of screening colonoscopy in average-risk persons.

Adenocarcinoma↗
PubMedDate not supplied

Effect of prophylactic main pancreatic duct stenting on the incidence of biliary endoscopic sphincterotomy-induced pancreatitis in high-risk patients.

Pancreatitis is a common complication of endoscopic sphincterotomy. Cautery-induced papillary edema has been implicated as a possible cause. The objective of this study was to determine whether prophylactic stenting of the main pancreatic duct after endoscopic sphincterotomy in high-risk patients would reduce the incidence of pancreatitis. High-risk patients were defined as those with sphincter of Oddi dysfunction, small common bile duct diameter (< 10 mm), or those requiring pre-cut sphincterotomy. Patients were studied in a prospective fashion from October 1990 to April 1992 and were randomized to receive either a main pancreatic duct stent or no stent after biliary sphincterotomy. The stents were generally removed 10 to 14 days after placement. Fifty patients were randomized to the no-stent group and 48 patients were randomized to the stent group, but in five patients stent placement was unsuccessful. Pancreatitis occurred in 18% of patients in the no-stent group compared with 14% of patients in the stent group. Most cases of pancreatitis were mild, occurring in 10% of patients in the no-stent group and 12% of patients in the stent group. Moderate to severe pancreatitis occurred with an increased frequency in patients in the no-stent group (8%) compared with that in patients in the stent group (2%). Mean number of hospital days required to treat pancreatitis was 9.5 days in the no-stent group compared with 2.8 days in the stent group; however, none of these differences reached statistical significance. Small common bile duct diameter (< 6 mm) was found to be an independent risk factor for pancreatitis after endoscopic sphincterotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Common Bile Duct↗