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EUS Yield in Evaluating Biliary Dilatation in Patients with Normal Liver Function Tests
Abstracts
W1247 EUS Yield in Evaluating Biliary Dilatation in Patients with Normal Liver Function Tests Shahid Malik, Asif Khalid, Kathy Bauer, Debra Brody, Adam Slivka, Kevin McGrath Background: The finding of common bile duct (CBD) dilation on abdominal imaging frequently results in additional testing. It has been our impression that EUS evaluation of a dilated CBD (O 7 mm) with normal LFTs is a low yield examination. We compared EUS findings to explain CBD dilatation in patients with both normal and abnormal LFTs, excluding jaundice (bilirubin O 3.5). Methods: We reviewed our database to identify patients referred for EUS evaluation of a dilated CBD in the absence of obvious pathology on index imaging. Patients with jaundice and known biliary strictures were excluded. Forty seven patients were identified from 1/02 to 10/04. Charts were reviewed to assess for LFT abnormalities, presence of symptoms, abdominal imaging tests, and EUS findings. Results: Index imaging consisted of computed tomography ((37/47), trans-abdominal ultrasound (17/47), MRCP (15/47) and ERCP (7/47). Sixty eight percent (32/47) of patients had normal LFTs. Eighty four percent of this cohort (27/32) had normal anatomy (ie no pathology to explain biliary dilatation). Forty percent (13/32) had prior cholecystectomy. Thirty two percent of patients (15/47) had abnormal LFTs. Forty seven percent (7/15) of this cohort had normal findings. Forty seven percent (7/15) also had prior cholecystectomy. See table for findings. There were no complications as a result of EUS. Conclusion: EUS evaluation of a dilated CBD in the setting of normal LFTs is of low yield. Although EUS is safe, MRCP should be considered in this setting as it is non-invasive. EUS is of higher diagnostic yield when LFTs are abnormal. Papillary stenosis cannot be addressed by EUS, the diagnosis of which should be pursued in patients who fulfill appropriate criteria.
available to participate in the first 20 cases of EUS-FNA. Residual material was rinsed and used for detection of codon 12 K-ras mutation by restriction fragment length polymorphism -PCR analysis. Efficacy of EUS-guided FNA biopsy and K-ras mutational analysis either alone or in combination was determined using surgical findings and/or clinical follow-up as gold-standard for definitive diagnosis. Results: A total of 220 samples were obtained: 3.1 passes/patient, range: 2-6. The presence of the cythopatologist did not influence the number of FNA passes (pZ0.35). Conclusion: EUS-guided FNA biopsy combined with K-ras mutational analysis is a strategy of higher sensitivity and accuracy for the diagnosis of pancreatic adenocarcinoma than each test alone.
W1249 Endoscopic Ultrasound Before Gastric Polypectomy: Is it Worthwhile? Yaakov Maor, Eytan Bardan, Carlos Simon, Maor Lahav, Dan Carter, Alon Lang, Moshe Nadler, Simon Bar-Meir, Benjamin Avidan
W1248 Detection of K-Ras Point Mutation Increases the Sensitivity of EUS-Guided FNA for the Diagnosis of Pancreatic Adenocarcinoma Fauze Maluf-Filho, Ma´rcia S. Kubrusly, Jose´ Eduardo M. da Cunha, ´rgio Matuguma, Paulo Sakai, Shinichi Ishioka, Marcel C. Machado, Se ´verson L. Artifon, Dalton M. Chaves, Joaquim J. Gama-Rodrigues E Background: in larger series, EUS-guided FNA sensitivity for the diagnosis of pancreatic adenocarcinoma (PA) is around 85 and 90%. Mutational activation of the K-ras at codon 12 has been demonstrated in 70-100% of the cases of PA. Aim: to evaluate the efficacy of EUS-guided FNA biopsy combined with K-ras point mutational analysis for the diagnosis of PA. Patients and Methods: From May/02 to April/04, 78 consecutive patients were submitted to EUS-FNA for the presence of a solid pancreatic mass. Five patients were excluded because the final diagnosis were peripancreatic malignant lymph nodes or tumors. Of the remaining 73 patients, 57 proved to harbor pancreatic adenocarcinoma, 10 pancreatitis and 6, non-functioning neuroendocrine pancreatic cancer. EUS-guided FNA was performed under conscious sedation using linear echoendoscope GFUC160P (Olympus Inc, Tokyo, Japan) and 22G EUSN-3 (Wilson-Cook, WS, USA). A minimum of three passes were intended during each procedure. A cythopatologist was
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Introduction: Vascularization of the base of a gastric polyp correlates with an increased risk for post-polypectomy bleeding. Such vessels may be detected by endoscopic ultrasound (EUS), therefore, safety measures may be undertaken. It is recommended that such polyps should be resected following EUS evaluation. Currently, no systematic review validates such recommendation. Aim: To assess the value of EUS evaluation to prevent post-polypectomy bleeding. Methods: All gastric polyps resected by snare polypectomy were evaluated. The primary outcome was the occurrence of immediate or delayed bleeding episodes. Post-polypectomy bleeding was correlated with the presence of blood vessels at the polyp base. Patient and polyp characteristics were analyzed as risk factors for post-polypectomy bleeding as well. Results: One-hundred and two snare polypectomies were undertaken. Resection of 7 (7%) polyps resulted in bleeding: immediate, self limited-6, delayed, major (7 days)-1 patient. No bleeding episode occurred in patients in whom EUS detected a blood vessel. Conclusions: The risk of bleeding after resection of gastric polyp is 7%. EUS evaluation before gastric polypectomy does not contribute to the safety of the procedure. Prospective studies are needed. Table. Patients, polyps and EUS characteristics of post-polypectomy bleeding
Volume 61, No. 5 : 2005 GASTROINTESTINAL ENDOSCOPY AB291
W1247 EUS Yield in Evaluating Biliary Dilatation in Patients with Normal Liver Function Tests Shahid Malik, Asif Khalid, Kathy Bauer, Debra Brody, Adam Slivka, Kevin McGrath Background: The finding of common bile duct (CBD) dilation on abdominal imaging frequently results in additional testing. It has been our impression that EUS evaluation of a dilated CBD (O 7 mm) with normal LFTs is a low yield examination. We compared EUS findings to explain CBD dilatation in patients with both normal and abnormal LFTs, excluding jaundice (bilirubin O 3.5). Methods: We reviewed our database to identify patients referred for EUS evaluation of a dilated CBD in the absence of obvious pathology on index imaging. Patients with jaundice and known biliary strictures were excluded. Forty seven patients were identified from 1/02 to 10/04. Charts were reviewed to assess for LFT abnormalities, presence of symptoms, abdominal imaging tests, and EUS findings. Results: Index imaging consisted of computed tomography ((37/47), trans-abdominal ultrasound (17/47), MRCP (15/47) and ERCP (7/47). Sixty eight percent (32/47) of patients had normal LFTs. Eighty four percent of this cohort (27/32) had normal anatomy (ie no pathology to explain biliary dilatation). Forty percent (13/32) had prior cholecystectomy. Thirty two percent of patients (15/47) had abnormal LFTs. Forty seven percent (7/15) of this cohort had normal findings. Forty seven percent (7/15) also had prior cholecystectomy. See table for findings. There were no complications as a result of EUS. Conclusion: EUS evaluation of a dilated CBD in the setting of normal LFTs is of low yield. Although EUS is safe, MRCP should be considered in this setting as it is non-invasive. EUS is of higher diagnostic yield when LFTs are abnormal. Papillary stenosis cannot be addressed by EUS, the diagnosis of which should be pursued in patients who fulfill appropriate criteria.
available to participate in the first 20 cases of EUS-FNA. Residual material was rinsed and used for detection of codon 12 K-ras mutation by restriction fragment length polymorphism -PCR analysis. Efficacy of EUS-guided FNA biopsy and K-ras mutational analysis either alone or in combination was determined using surgical findings and/or clinical follow-up as gold-standard for definitive diagnosis. Results: A total of 220 samples were obtained: 3.1 passes/patient, range: 2-6. The presence of the cythopatologist did not influence the number of FNA passes (pZ0.35). Conclusion: EUS-guided FNA biopsy combined with K-ras mutational analysis is a strategy of higher sensitivity and accuracy for the diagnosis of pancreatic adenocarcinoma than each test alone.
W1249 Endoscopic Ultrasound Before Gastric Polypectomy: Is it Worthwhile? Yaakov Maor, Eytan Bardan, Carlos Simon, Maor Lahav, Dan Carter, Alon Lang, Moshe Nadler, Simon Bar-Meir, Benjamin Avidan
W1248 Detection of K-Ras Point Mutation Increases the Sensitivity of EUS-Guided FNA for the Diagnosis of Pancreatic Adenocarcinoma Fauze Maluf-Filho, Ma´rcia S. Kubrusly, Jose´ Eduardo M. da Cunha, ´rgio Matuguma, Paulo Sakai, Shinichi Ishioka, Marcel C. Machado, Se ´verson L. Artifon, Dalton M. Chaves, Joaquim J. Gama-Rodrigues E Background: in larger series, EUS-guided FNA sensitivity for the diagnosis of pancreatic adenocarcinoma (PA) is around 85 and 90%. Mutational activation of the K-ras at codon 12 has been demonstrated in 70-100% of the cases of PA. Aim: to evaluate the efficacy of EUS-guided FNA biopsy combined with K-ras point mutational analysis for the diagnosis of PA. Patients and Methods: From May/02 to April/04, 78 consecutive patients were submitted to EUS-FNA for the presence of a solid pancreatic mass. Five patients were excluded because the final diagnosis were peripancreatic malignant lymph nodes or tumors. Of the remaining 73 patients, 57 proved to harbor pancreatic adenocarcinoma, 10 pancreatitis and 6, non-functioning neuroendocrine pancreatic cancer. EUS-guided FNA was performed under conscious sedation using linear echoendoscope GFUC160P (Olympus Inc, Tokyo, Japan) and 22G EUSN-3 (Wilson-Cook, WS, USA). A minimum of three passes were intended during each procedure. A cythopatologist was
www.mosby.com/gie
Introduction: Vascularization of the base of a gastric polyp correlates with an increased risk for post-polypectomy bleeding. Such vessels may be detected by endoscopic ultrasound (EUS), therefore, safety measures may be undertaken. It is recommended that such polyps should be resected following EUS evaluation. Currently, no systematic review validates such recommendation. Aim: To assess the value of EUS evaluation to prevent post-polypectomy bleeding. Methods: All gastric polyps resected by snare polypectomy were evaluated. The primary outcome was the occurrence of immediate or delayed bleeding episodes. Post-polypectomy bleeding was correlated with the presence of blood vessels at the polyp base. Patient and polyp characteristics were analyzed as risk factors for post-polypectomy bleeding as well. Results: One-hundred and two snare polypectomies were undertaken. Resection of 7 (7%) polyps resulted in bleeding: immediate, self limited-6, delayed, major (7 days)-1 patient. No bleeding episode occurred in patients in whom EUS detected a blood vessel. Conclusions: The risk of bleeding after resection of gastric polyp is 7%. EUS evaluation before gastric polypectomy does not contribute to the safety of the procedure. Prospective studies are needed. Table. Patients, polyps and EUS characteristics of post-polypectomy bleeding
Volume 61, No. 5 : 2005 GASTROINTESTINAL ENDOSCOPY AB291