EUS-guided pancreaticogastrostomy: invasive endosonography coming of age.
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Cholangiopancreatography, Endoscopic Retrograde↗
Biomedical subjects
Richard A Erickson
Publications and source records attributed to Richard A Erickson.
Endoscopic ultrasound as a first test for diagnosis and staging of lung cancer: a prospective study.
RATIONALE: Multiple tests are required for the management of lung cancer. OBJECTIVES: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) was evaluated as a single test for the diagnosis and staging (thoracic and extrathoracic) of lung cancer. METHODS: Consecutive subjects with computed tomography (CT) findings of a lung mass were enrolled for EUS and results were compared with those from CT and positron emission tomography scans. RESULTS: Of 113 subjects with lung cancer, EUS was performed as a first test (after CT scan) for diagnosis in 93 (82%) of them. EUS-FNA established tissue diagnosis in 70% of cases. EUS-FNA, CT, and positron emission tomography detected metastases to the mediastinal lymph nodes with accuracies of 93, 81, and 83%, respectively. EUS-FNA was significantly better than CT at detecting distant metastases (accuracies of 97 and 89%, respectively; p = 0.02). Metastases to lymph nodes at the celiac axis (CLNs) were observed in 11% of cases. The diagnostic yields of EUS-FNA and CT for detection of metastases to the CLNs were 100 and 50%, respectively (p < 0.05). EUS was able to detect small metastases (less than 1 cm) often missed by CT. Metastasis to the CLNs was a predictor of poor survival of subjects with non-small cell lung cancer, irrespective of the size of the CLNs. Of 44 cases with resectable tumor on CT scan, EUS-FNA avoided thoracotomy in 14% of cases. CONCLUSIONS: EUS-FNA as a first test (after CT) has high diagnostic yield and accuracy for detecting lung cancer metastases to the mediastinum and distant sites. Metastasis to the CLNs is associated with poor prognosis. EUS-FNA is able to detect occult metastasis to the CLNs and thus avoids thoracotomy.
Aged↗
"Hot stuff": EUS-guided brachytherapy.
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Biopsy, Fine-Needle↗
ERCP and pancreatic cancer.
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Cholangiopancreatography, Endoscopic Retrograde↗
Acute pancreatitis after EUS-guided FNA of solid pancreatic masses: a pooled analysis from EUS centers in the United States.
BACKGROUND: The aim of this study was to determine the frequency and the severity of pancreatitis after EUS-guided FNA of solid pancreatic masses. A survey of centers that offer training in EUS in the United States was conducted. METHODS: A list of centers in which training in EUS is offered was obtained from the Web site of the American Society for Gastrointestinal Endoscopy. Designated program directors were contacted via e-mail. The information requested included the number of EUS-guided FNA procedures performed for solid pancreatic masses, the number of cases of post-procedure pancreatitis, and the method for tracking complications. For each episode of pancreatitis, technical details were obtained about the procedure, including the location of the mass, the type of fine needle used, the number of needle passes, and the nature of the lesion. RESULTS: Nineteen of the 27 programs contacted returned the questionnaire (70%). In total, 4909 EUS-guided FNAs of solid pancreatic masses were performed in these 19 centers over a mean of 4 years (range 11 months to 9 years). Pancreatitis occurred after 14 (0.29%): 95% CI[0.16, 0.48] procedures. At two centers in which data on complications were prospectively collected, the frequency of acute pancreatitis was 0.64%, suggesting that the frequency of pancreatitis in the retrospective cohort (0.26%) was under-reported (p=0.22). The odds that cases of pancreatitis would be reported were 2.45 greater for the prospective compared with the retrospective cohort (95% CI[0.55, 10.98]). The median duration of hospitalization for treatment of pancreatitis was 3 days (range 1-21 days). The pancreatitis was classified as mild in 10 cases, moderate in 3, and severe in one; one death (proximate cause, pulmonary embolism) occurred after the development of pancreatitis in a patient with multiple comorbid conditions. CONCLUSIONS: EUS-guided FNA of solid pancreatic masses is infrequently associated with acute pancreatitis. The procedure appears to be safe when performed by experienced endosonographers. The frequency of post EUS-guided FNA pancreatitis may be underestimated by retrospective analysis.
Acute Disease↗
TGF-beta and p53 staining in CT-guided and endoscopic ultrasound fine-needle aspirates of pancreatic adenocarcinoma.
Our purpose was to determine if fine-needle aspirates of pancreatic adenocarcinoma would produce material amenable to tumor marker staining and to correlate the expression of TGF-beta and p53 with patient and tumor data. One hundred twenty specimens were analyzed. TGF-beta was positive in 26% of cases and had no correlation with patient's age, sex, survival, stage, grade, or size. p53 was positive in 22% of the cases and correlated only with grade 1 tumors. Expression of TGF-beta and p53 can be tested on preserved cytologic specimens. This is the largest study to date correlating TGF-beta and p53 expression in pancreatic adenocarcinoma and patient demographics, prognosis, and tumor attributes. This is also the first study that did not select for surgical candidates. TGF-beta expression does not appear to have prognostic significance in pancreatic cancer. p53 was more common in well-differentiated tumors and may be an early mutation lost in more poorly differentiated tumors.
Adenocarcinoma↗
A resource utilization projection study of EUS.
BACKGROUND: EUS has emerged as standard practice with respect to the diagnosis and staging of GI malignancies. Whether currently available resources are sufficient to meet the potential need for EUS is uncertain. This study examines the hypothetical demand for EUS in the United States. METHODS: EUS cases performed at 3 centers with well-established expertise in EUS in 1997 were retrospectively reviewed and trends were extrapolated to national cancer statistics. Indications for EUS fell into 3 categories: (1) diagnosis/staging of esophageal, gastric, pancreatic, or rectal cancers (established indications); (2) suspected GI malignancy (obligate "rule out"); and (3) "other" (emerging indications). Hypothetical total numbers of cases in which EUS could be performed in the United States were calculated taking into consideration the expected number of GI malignancies for which EUS would be appropriate (based on cancer statistics for 2000), the fraction unresectable by CT, the fraction of elderly nonsurgical candidates, proportionate "rule out" cases, as well as "other" emerging indications. RESULTS: The calculated hypothetical number of cases (United States) in which EUS would be indicated is 79,568 per year (10,287 esophagus, 10,666 stomach, 23,069 pancreas, and 35,546 rectal). If "other" indications remained constant at 12%, there would potentially be 89,116 EUS procedures performed per year, with a conservative estimate of 79,572 per year. CONCLUSIONS: This model suggests that currently available EUS resources are not sufficient to meet hypothetical demand. Future considerations include the number of endoscopy units in which EUS is performed, the capacity of individual units, and the implications for training programs in the United States.
Digestive System Neoplasms↗
EUS-guided fine needle aspiration of the liver: indications, yield, and safety based on an international survey of 167 cases.
BACKGROUND: The liver is a common site of metastases for various malignancies. EUS-guided fine needle aspiration (EUS-FNA) of liver masses has only been reported in small series from single centers. METHODS: A retrospective questionnaire was sent by e-mail to 130 EUS-FNA centers around the world regarding indications, complications, and findings of EUS-FNA of the liver. RESULTS: Twenty-one centers reported 167 cases of EUS-FNA of the liver. A complication was reported in 6 (4%) of 167 cases including the following: death in 1 patient with an occluding biliary stent and biliary sepsis, bleeding (1), fever (2), and pain (2). EUS-FNA diagnosed malignancy in 23 of 26 (89%) cases after nondiagnostic fine needle aspiration under transabdominal US guidance. EUS localized an unrecognized primary tumor in 17 of 33 (52%) cases in which CT had demonstrated only liver metastases. EUS image characteristics were not predictive of malignant versus benign lesions. CONCLUSION: EUS-guided FNA of the liver appears to be a safe procedure with a major complication rate of approximately 1%. EUS-FNA should be considered when a liver lesion is poorly accessible to US-, or CT-guided FNA should be considered when US- or CT-guided FNA fail to make a diagnosis, when a liver lesion(s) is detected (de novo) by EUS, and for investigation of possible upper GI primary tumors in the setting of liver metastases.
Attitude of Health Personnel↗