- Email: [email protected]
EUS assessment of GI subepithelial tumors
Abstracts
(79.80%) were cirrhotic. On EGD, 25% were without EV, 55.77% had small varices (Paquet I–II) and 19.23% had large varices (Paquet III– IV). Portal vein, splenic vein and spleen diameter were significantly higher in patients with large varices than those with small or no varices, while platelet count was significantly lower. APRI, ASPRI and SPRI scores were good predictors for the presence of large varices on endoscopy (AUROC 0.652, 0.703 and 0.702 respectively). The three scores performed even better when predicting both large varices or small varices with red marks (AUROC 0.758, 0.806 and 0.803). They also had good accuracy for predicting gastric varices (AUROC 0.676, 0.711 and 0.719). Conclusions: These simple non-invasive scores can accurately predict high-risk esophageal varices in liver disease patients, targeting those who need to undergo EGD and prophylactic treatment.
OF
doi:10.1016/j.ejim.2013.08.214
ID: 584 EUS assessment of GI subepithelial tumors M. Jingaa,b, E. Simsensohnb, B.G. Floreab, F. Vasilescuc, I. Sandrab, S. Bucuricaa,b, A.R. Cazanb, A. Toporb, V. Jingab, D.V. Balabana a
Gastroenterology, Dr Carol Davila Central Military Emergency University Hospital, Bucharest, Romania b Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania c Pathology, Dr Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
DP
Introduction: Superior mesenteric artery (SMA) syndrome or Wilkie's syndrome, is a rare acquired vascular compression disorder in which acute angulation of superior mesenteric artery (SMA) results in compression of the third part of the duodenum leading to obstruction. Case report: Female, 25 years old, was hospitalized with abdominal pain, early satiety, epigastric fullness, nausea, vomiting of partially digested food, and 8 kg weight loss over 2 months. She had a history of chronic gastritis and lactose intolerance. Previously clinical investigation excluded Gastroenterology or Neuro-psychiatric disorders and was sent to Internal Medicine Ward. Physical examination revealed a cachectic patient. (W: 45 kg, H: 1,55 m: BMI: 18.75) Abdominal examination revealed non distended abdomen, mild epigastric tenderness, and hyperactive bowel sounds. There was no palpable organomegaly or clinical signs of ascites. She was treated with fasting, parenteral glucose solution, IBP and domperidona and metoclopramide. An extrapyramidal complication of the use of neuroleptic was described on the second day. Analytical showed normochromic anemia and mid hipoproteinemia. Abdominal radiograph revealed a dilated stomach. Subsequent abdominal computerized tomography (CT) scan showed a compression of third part of duodenum. An angio IRM confirmed a diminution of aortomesenteric angle (b24 cm) suggesting Wilkie's syndrome. The patient was treated with enteric diet through nasoyeyunal tube followed by frequent small meals and posturing maneuvers, with a progressive improvement. The patient was discharged asymptomatic. Conclusion: The defining feature of this entity is upper gastrointestinal obstruction caused by compression of the third part of the duodenum between the SMA anteriorly and the aorta posteriorly. Chronic cases may present with long-standing vague abdominal symptoms, early satiety and anorexia, or recurrent episodes of abdominal pain, associated with vomiting and interpreted for psychiatric disorders like in our patient. The diagnosis is based on clinical symptoms and radiologic evidence of obstruction and treatment has consisted of conservative measures like in our patient. In several cases a Laparoscopic surgery might be the solution.
RO
e86
TE
Introduction: Endoscopic ultrasound (EUS) is considered the best diagnostic tool for evaluation of subepithelial lesions of the GI tract, allowing morphological characterization and tissue sampling. Material and methods: We retrospectively studied 144 patients referred for EUS assessment of subepithelial GI tumors between 2001 and 2012. Data regarding ultrasonographic characteristics of the tumor (echotexture, echogenicity, shape, size, border, originating layer, Dopper and elastograhic features) were collected from the EUS log. Results: Of the 144 patients, 57% were male and the mean age was 59.45 years. Most of the tumors (95.84%) were located in the upper GI tract, while only 6 (4.16%) were rectal subepithelial lesions. Of the 138 upper GI tract tumors (11 extrinsic compressions and 127 intramural), 39.86% were located in the esophagus, 6.52% at the GE junction, 47.10% in the stomach and 6.52% in the duodenum. Regarding the echo pattern, 89.58% of the lesions were solid, 5.56% cystic, 3.47% mixed and 1.39% vascular. EUS accurately identified the layer of origin or layer involvement in 129 of the 133 true submucosal tumors. With the aid of EUS-FNA and surgery in some cases, 61 patients had a final diagnosis — among these there were 15 leiomyomas, 10 GISTs, 2 lymphomas, 2 sarcoid nodules, 1 teratoma and 1 schwanomma. The remaining 83 were recommended follow-up. Conclusions: EUS is a valuable diagnostic tool for subepithelial GI tumors. Ultrasound features on EUS can be useful in guiding either follow-up or FNA sampling and surgery.
EC
doi:10.1016/j.ejim.2013.08.213
a
RR
ID: 581 Noninvasive predictors of high-risk varices in chronic liver disease patients D.V. Balabana, B.G. Floreab, A.R. Cazanb, A.L. Popescua, V. Jingab, A. Stancab, P. Nutaa, R.S. Costachea, F. Ionita-Radua, M. Jingaa,b
CO
Gastroenterology, Dr Carol Davila Central Military Emergency University Hospital, Bucharest, Romania b Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
UN
Objective: Esophageal varices (EV) are a major complication of portal hypertension in chronic liver disease patients. Follow-up of cirrhotics by periodical upper GI endoscopy can be quite costly and poorly accepted by patients. In this setting we need to identify noninvasive models to predict the presence of high-risk varices (large varices and varices with red marks). Materials and methods: We retrospectively studied 104 patients with chronic liver disease (hepatitis or cirrhosis) of various etiologies (viral, ethanolic, autoimmune, drug-induced) admitted to out unit in 2012. Clinical, biological, ultrasonographic and endoscopic data were collected from their charts and used to calculate the APRI (AST to platelets ratio index), ASPRI (agespleen-platelets ratio index) and SPRI (spleen to platelets ratio index) scores. The diagnostic performance of these scores was evaluated by the area under the receiver operating characteristic curve (AUROC). Results: Of the 104 patients (62.5% males, mean age 62 years), 83
doi:10.1016/j.ejim.2013.08.215
ID: 586 Dyspepsia management traps C.G. Cheranaa, A.E. Ranettib,c, C. Spiroiub, C. Jurcutd, A.L. Popescua, D.V. Balabana, M. Jingaa,c a
Gastroenterology, Dr Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
(79.80%) were cirrhotic. On EGD, 25% were without EV, 55.77% had small varices (Paquet I–II) and 19.23% had large varices (Paquet III– IV). Portal vein, splenic vein and spleen diameter were significantly higher in patients with large varices than those with small or no varices, while platelet count was significantly lower. APRI, ASPRI and SPRI scores were good predictors for the presence of large varices on endoscopy (AUROC 0.652, 0.703 and 0.702 respectively). The three scores performed even better when predicting both large varices or small varices with red marks (AUROC 0.758, 0.806 and 0.803). They also had good accuracy for predicting gastric varices (AUROC 0.676, 0.711 and 0.719). Conclusions: These simple non-invasive scores can accurately predict high-risk esophageal varices in liver disease patients, targeting those who need to undergo EGD and prophylactic treatment.
OF
doi:10.1016/j.ejim.2013.08.214
ID: 584 EUS assessment of GI subepithelial tumors M. Jingaa,b, E. Simsensohnb, B.G. Floreab, F. Vasilescuc, I. Sandrab, S. Bucuricaa,b, A.R. Cazanb, A. Toporb, V. Jingab, D.V. Balabana a
Gastroenterology, Dr Carol Davila Central Military Emergency University Hospital, Bucharest, Romania b Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania c Pathology, Dr Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
DP
Introduction: Superior mesenteric artery (SMA) syndrome or Wilkie's syndrome, is a rare acquired vascular compression disorder in which acute angulation of superior mesenteric artery (SMA) results in compression of the third part of the duodenum leading to obstruction. Case report: Female, 25 years old, was hospitalized with abdominal pain, early satiety, epigastric fullness, nausea, vomiting of partially digested food, and 8 kg weight loss over 2 months. She had a history of chronic gastritis and lactose intolerance. Previously clinical investigation excluded Gastroenterology or Neuro-psychiatric disorders and was sent to Internal Medicine Ward. Physical examination revealed a cachectic patient. (W: 45 kg, H: 1,55 m: BMI: 18.75) Abdominal examination revealed non distended abdomen, mild epigastric tenderness, and hyperactive bowel sounds. There was no palpable organomegaly or clinical signs of ascites. She was treated with fasting, parenteral glucose solution, IBP and domperidona and metoclopramide. An extrapyramidal complication of the use of neuroleptic was described on the second day. Analytical showed normochromic anemia and mid hipoproteinemia. Abdominal radiograph revealed a dilated stomach. Subsequent abdominal computerized tomography (CT) scan showed a compression of third part of duodenum. An angio IRM confirmed a diminution of aortomesenteric angle (b24 cm) suggesting Wilkie's syndrome. The patient was treated with enteric diet through nasoyeyunal tube followed by frequent small meals and posturing maneuvers, with a progressive improvement. The patient was discharged asymptomatic. Conclusion: The defining feature of this entity is upper gastrointestinal obstruction caused by compression of the third part of the duodenum between the SMA anteriorly and the aorta posteriorly. Chronic cases may present with long-standing vague abdominal symptoms, early satiety and anorexia, or recurrent episodes of abdominal pain, associated with vomiting and interpreted for psychiatric disorders like in our patient. The diagnosis is based on clinical symptoms and radiologic evidence of obstruction and treatment has consisted of conservative measures like in our patient. In several cases a Laparoscopic surgery might be the solution.
RO
e86
TE
Introduction: Endoscopic ultrasound (EUS) is considered the best diagnostic tool for evaluation of subepithelial lesions of the GI tract, allowing morphological characterization and tissue sampling. Material and methods: We retrospectively studied 144 patients referred for EUS assessment of subepithelial GI tumors between 2001 and 2012. Data regarding ultrasonographic characteristics of the tumor (echotexture, echogenicity, shape, size, border, originating layer, Dopper and elastograhic features) were collected from the EUS log. Results: Of the 144 patients, 57% were male and the mean age was 59.45 years. Most of the tumors (95.84%) were located in the upper GI tract, while only 6 (4.16%) were rectal subepithelial lesions. Of the 138 upper GI tract tumors (11 extrinsic compressions and 127 intramural), 39.86% were located in the esophagus, 6.52% at the GE junction, 47.10% in the stomach and 6.52% in the duodenum. Regarding the echo pattern, 89.58% of the lesions were solid, 5.56% cystic, 3.47% mixed and 1.39% vascular. EUS accurately identified the layer of origin or layer involvement in 129 of the 133 true submucosal tumors. With the aid of EUS-FNA and surgery in some cases, 61 patients had a final diagnosis — among these there were 15 leiomyomas, 10 GISTs, 2 lymphomas, 2 sarcoid nodules, 1 teratoma and 1 schwanomma. The remaining 83 were recommended follow-up. Conclusions: EUS is a valuable diagnostic tool for subepithelial GI tumors. Ultrasound features on EUS can be useful in guiding either follow-up or FNA sampling and surgery.
EC
doi:10.1016/j.ejim.2013.08.213
a
RR
ID: 581 Noninvasive predictors of high-risk varices in chronic liver disease patients D.V. Balabana, B.G. Floreab, A.R. Cazanb, A.L. Popescua, V. Jingab, A. Stancab, P. Nutaa, R.S. Costachea, F. Ionita-Radua, M. Jingaa,b
CO
Gastroenterology, Dr Carol Davila Central Military Emergency University Hospital, Bucharest, Romania b Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
UN
Objective: Esophageal varices (EV) are a major complication of portal hypertension in chronic liver disease patients. Follow-up of cirrhotics by periodical upper GI endoscopy can be quite costly and poorly accepted by patients. In this setting we need to identify noninvasive models to predict the presence of high-risk varices (large varices and varices with red marks). Materials and methods: We retrospectively studied 104 patients with chronic liver disease (hepatitis or cirrhosis) of various etiologies (viral, ethanolic, autoimmune, drug-induced) admitted to out unit in 2012. Clinical, biological, ultrasonographic and endoscopic data were collected from their charts and used to calculate the APRI (AST to platelets ratio index), ASPRI (agespleen-platelets ratio index) and SPRI (spleen to platelets ratio index) scores. The diagnostic performance of these scores was evaluated by the area under the receiver operating characteristic curve (AUROC). Results: Of the 104 patients (62.5% males, mean age 62 years), 83
doi:10.1016/j.ejim.2013.08.215
ID: 586 Dyspepsia management traps C.G. Cheranaa, A.E. Ranettib,c, C. Spiroiub, C. Jurcutd, A.L. Popescua, D.V. Balabana, M. Jingaa,c a
Gastroenterology, Dr Carol Davila Central Military Emergency University Hospital, Bucharest, Romania