Biomedical subjects

Nadim G Haddad

Publications and source records attributed to Nadim G Haddad.

4 recordsLinked to original sources

PubMed2006

Single-step EUS-guided pancreatic pseudocyst drainage using a large channel linear array echoendoscope and cystotome: results in 11 patients.

CONTEXT: EUS-guided transmural drainage of pancreatic pseudocyst has been reported using a linear array echoendoscope; however, placement of large 10 French stent was not feasible because of the limited diameter of the working channel. Recently linear array echoendoscopes with large working channel (3.7 to 3.8 mm) and newer accessories for pancreatic cyst puncture have become available; however, clinical data on their efficacy and safety in pancreatic pseudocyst drainage is not available. OBJECTIVE: To evaluate efficacy and safety of a one-step real time EUS-guided pancreatic pseudocyst drainage approach using a 3.8 mm channel linear array echoendoscope and cystotome. DESIGN: Prospective case series. SETTING: Tertiary care hospital endoscopy unit. PATIENTS AND INTERVENTIONS: A total of 12 EUS-guided pancreatic pseudocyst drainage procedures were performed in 11 patients with symptomatic pancreatic pseudocyst using a 3.8 mm channel linear array echoendoscope and cystotome. MAIN OUTCOME MEASUREMENTS: Complete resolution of pancreatic pseudocyst on imaging. RESULTS: Successful puncture of pancreatic pseudocyst and placement of 1 or 2 stents (10 Fr) was successful in all patients who were considered eligible for EUS-guided pancreatic pseudocyst drainage. Overall 9 patients out of a total of 11 (82%) were managed successfully with EUS-guided pseudocyst drainage. Two recurrences were noted over a mean follow-up period of 4 months (range 3-6 months). One patient underwent successful repeat drainage and the other patient was managed with surgical cystogastrostomy because of infected cyst contents. No major complication occurred. LIMITATIONS: Uncontrolled, small sample size. CONCLUSIONS: A single-step approach using a large channel (3.8 mm) linear array echoendoscope and cystotome appears feasible. This approach appears safe and effective in managing selected patients with symptomatic pancreatic pseudocysts.

Adult↗

PubMed2006

Role of EUS and EUS-guided FNA in the diagnosis of symptomatic rectosigmoid endometriosis.

BACKGROUND: Rectosigmoid endometriosis is an underrecognized cause of GI symptoms in women. Pelvic magnetic resonance imaging and CT have a low sensitivity in making this diagnosis. The role of EUS and EUS-guided FNA (EUS-FNA) in the diagnosis of rectosigmoid endometriosis in symptomatic patients is not well studied. METHODS: A review of medical records identified 5 women who were diagnosed with rectosigmoid endometriosis by EUS and EUS-FNA over a period of 1 year. OBSERVATIONS: Five women with nonspecific GI complaints underwent EUS examination of a rectosigmoid subepithelial mass found on colonoscopy. EUS revealed a hypoechoic lesion infiltrating the muscularis propria and the serosa of the rectal wall, and extending outside the rectal wall, findings consistent with rectosigmoid endometriosis. This diagnosis was confirmed by EUS-FNA, surgical exploration, and/or the patient's clinical course. CONCLUSIONS: EUS and EUS-FNA are noninvasive, sensitive techniques for the diagnosis of rectosigmoid endometriosis in symptomatic patients.

Adult↗

PubMed2006

EUS-guided fiducial placement for CyberKnife radiotherapy of mediastinal and abdominal malignancies.

BACKGROUND: The CyberKnife frameless image-guided stereotactic radiosurgery system delivers radiation doses to tumors with high precision by use of real-time image guidance. Radiographic markers (or fiducials) implanted at the tumor site are used as reference points by the system to target the radiation beams. Diagnostic and interventional EUS have multiple applications in the multidisciplinary approach to tumors. OBJECTIVE: The goal of this prospective study was to evaluate the safety and feasibility of placing fiducials in mediastinal and intra-abdominal tumors under EUS guidance. DESIGN: Patients were evaluated for EUS-guided fiducial placement. A linear echoendoscope was used to localize the tumor, insert a 19-gauge fine needle in the target area, and place the fiducials through the needle lumen. The position of the fiducials was verified by EUS and by fluoroscopy. SETTING: Georgetown University Hospital, between February 2005 and August 2005. PATIENTS: Thirteen patients scheduled to undergo CyberKnife radiation therapy. RESULTS: EUS-guided fiducial placement was successful in a total of 11 of 13 patients (84.6%). The locations of the tumors were as follows: retrocrural area at the dome of the diaphragm, porta hepatis, gastroesophageal junction, mediastinum, thoracic paraspinal area, and pancreas. A total of 3 to 6 fiducials were placed in each patient. An infectious complication developed in 1 patient within 30 days of the procedure. CONCLUSION: EUS-guided fiducial placement in lesions of the mediastinum and abdomen is a feasible and safe technique that can be used to mark a tumor site and guide CyberKnife radiation therapy. This new application of interventional EUS further expands the role of EUS in the multidisciplinary approach to the oncology patient.

Abdominal Neoplasms↗

PubMed2005

Pancreatic tuberculosis diagnosed with endoscopic ultrasound guided fine needle aspiration.

CONTEXT: Isolated pancreatic tuberculosis is rare in the Western world. Its clinical presentation often mimics pancreatic malignancy and the diagnosis is usually not suspected or confirmed prior to laparotomy. Endoscopic ultrasound guided fine needle aspiration cytology has proved to be an excellent tool for the cytological diagnosis of pancreatic and peripancreatic masses. However, this technique has not been reported for diagnosing pancreatic or peripancreatic tuberculosis. CASE REPORT: We describe a 57-year-old South Asian man with pancreatic tuberculosis who presented with fever of undetermined origin and a pancreatic mass on imaging. He was successfully treated with anti-tuberculosis regimen following confirmation of his diagnosis with endoscopic ultrasound guided fine needle aspiration cytology. CONCLUSIONS: Pancreatic tuberculosis should be suspected in patients having a pancreatic mass, particularly if patient presents with fever and lived in, or traveled to, an area of endemic tuberculosis or exposed to tuberculosis. When the diagnosis is suspected, endoscopic ultrasound guided fine needle aspiration cytology of the pancreatic lesion can confirm the diagnosis and so avoid an unnecessary explorative laparotomy or pancreatic resection.

Adult↗