- Email: [email protected]
I-Scan Technology is Useful to Improve the Rate of Gastric Varices Diagnosis in Patients With Portal Hypertension
by serial balloon dilations were implemented to successfully manage this stricture. The final patient sustained a caustic oropharyngeal injury resulting in a proximal esophageal stricture refractory to reconstructive surgery and multiple attempts at stenting. By combining CARD with APC and needle knife dissection, the patient's stricture was successfully recanalized and patency was maintained. Conclusions: Occlusive esophageal strictures pose a difficult challenge to gastroenterologists and little has been reported with regards to their management. Using the CARD technique, needle knife dissection and APC, individually or in combination, luminal patency of occlusive esophageal strictures can be accomplished.
Tu1152
Endoscopic ultrasound (EUS) has become a standard diagnostic tool for staging pancreatic lesions. As hypoechogenicity is not a soul sign of pancreatic adenocarcinoma but e.g. is also seen for neuroendocrine carcinoma as well as for metastasis one usually has to perform EUS-guided fine needle aspiration with all its limitations in order to decide which form of treatment to choose. Contrast enhanced ultrasound has been used for several years in transabdominal ultrasound and proofed to be effective in discriminating different lesions especially in the liver looking at the blood perfusion characteristics. As with the newest generation of endoscopic ultrasound machines contrast enhanced harmonic endoscopic ultrasound (CEH-EUS) has become a new option the aim of our study was to evaluate whether CEH-EUS may help to discriminate pancreatic adenocarcinoma from other malignant and non-malignant pancreatic lesions. Methods: Twenty consecutive patients with suspicious pancreatic lesions where investigated with CEH-EUS after standard EUS procedures. Patients received intravenously 5 ml contrast agent (SonoVue, Bracco, Inc.) followed by a 10 ml saline flush. Ultrasound sequences were documented as a video file and perfusion characteristics determined immediately after investigation. Time intensity curves were calculated and compared to areas of normal appearing pancreatic tissue in the same individual. Samples from EUS-fine needle aspirates of the suspicious lesions or surgical resections, where applicable, served as gold standard. Results: CEH-EUS showed 12 lesions with reduced contrast enhancement (intensity 8±4db), 8 lesions showed up hyper- or isoenhanced. 8 pancreatic adenocarcinomas, proven by histology, showed up hypoenhanced. Hyperenhanced lesions (n=5, intensity 48±7db) included 3 neuroendocrine carinomas, 1 metastasis of a renal cell carcinoma and 1 lymphoma. Sensitivity regarding pancreatic adenocarcinomas was 100%, specificity 75%. In 4 patients with chronic pancreatitis, chronic inflammatory masses showed up with reduced contrast enhancement, while 3 showed up isoenhanced. No malignancies in patients with chronic pancreatitis were detected in this set of patients. Conclusion: CE-EUS has shown to be helpful in the evaluation of suspicious pancreatic masses clearly differentiating between pancreatic adenocarcinoma versus neuroendocrine/metastatic lesions. We therefore suggest the following algorithm: An endosonographic hypoenhanced hypoechogenic pancreatic lesion in otherwise normal appearing pancreatic tissue without contraindication for surgery can be send for surgical therapy without prior histological evaluation while lesions showing hyperenhancement during CE-EUS should be further evaluated e.g. by EUS-fine needle aspiration.
Fluoroscopy of strictured esophagus.
Tu1153 I-Scan Technology is Useful to Improve the Rate of Gastric Varices Diagnosis in Patients With Portal Hypertension Lucia Sparano, Gianluca Ianiro, Marialuisa Novi, Immacolata A. Cazzato, Antonio Gasbarrini, Giovanni Cammarota BACKGROUND Gastric varices (GVs) are common in patients with portal hypertension and gastric variceal bleeding is associated with high mortality and morbidity rates. GVs may appear similar to enlarged gastric folds and submucosal lesions at standard endoscopy. A simple endoscopic method to diagnose GVs could be clinically useful. I-scan technology (IST) from PENTAX is a newly developed endoscopic tool that utilizes a digital contrast method to enhance endoscopic image in real time. MATERIALS AND METHODS Forty-three patients with documented history of portal hypertension, prospectively recruited, underwent upper endoscopy for evaluation of esophageal and gastric varices. All examinations were performed by a single endoscopist with high experience in the standard evaluation of esophageal and gastric varices and in the use of I-ST for the assessment of esophageal varices. Each patient was evaluated, during endoscopy, by using standard view before switching to I-ST . RESULTS Standard endoscopy revealed the presence of GVs in 4 patients of 43 (9,3%). Using I-ST, GVs were detected in 12 patients of 43 (27,9%). The four cases of GVs diagnosis at standard endoscopy were confirmed by I-ST. CONCLUSIONS Our results demonstrate that I-ST is a simple and useful method able to significantly improve the rate of GVs diagnosis in patients with portal hypertension. However, more investigations are necessary in a larger number of subjects to confirm these preliminary results and to determine the real clinical utility of this technology.
Esophageal patency achieved after CARD. A view from the stomach. Tu1151 Contrast Enhanced Endoscopic Ultrasound is a Helpful Tool to Differentiate Gastrointestinal Stromatumors From Benign Lesions Klaus Kannengiesser, Reiner Mahlke, Frauke Petersen, Torsten F. Kucharzik, Christian Maaser Since its introduction endoscopic ultrasound (EUS) has shown to be a helpful tool in endoscopic diagnostics, allowing precise detection of not only pancreatic masses, but also evaluation of esophageal, gastric and biliary lesions, while differentiation of benign and malignant lesions remains difficult. Gastric lesions with suspicion of gastrointestinal stromatumors (GIST) or benign lesions like lipoma or leiomyoma can often not be accurately differentiated by just using endoscopic ultrasound therefore requiring tissue sampling from the submucosal tissue after needle insertion with the risk of bleeding side effects especially in GIST. Contrast enhanced ultrasound has been used for several years in transabdominal ultrasound and proofed to be effective in discriminating various lesions e.g. in the liver through their blood perfusion characteristics. As with the newest generation of endoscopic ultrasound machines contrast enhanced harmonic endoscopic ultrasound (CEH-EUS) has become a new option the aim of our study was to evaluate whether CEH-EUS may help to discriminate various gastric/esophageal lesions. Methods: 10 patients with suspicious gastric or esophageal lesions where investigated with CEH-EUS after standard EUS procedures. Patients received 5 ml contrast agent (SonoVue, Bracco, Inc.) followed by a 10 ml saline flush. Ultrasound sequences were documented as a video file and perfusion characteristics determined immediately after investigation. Samples from EUS-fine needle aspirates, biopsy samples from the submucosal tissue after needle cut or surgical specimen, where applicable, served as gold standard. Results: CEH-EUS showed 5 lesions with reduced contrast enhancement (maximum intensity 6 ± 4db) and 5 lesions with hyperenhancement (maximum intensity 50 ± 20db). The latter 5 lesions where all histological identified as GIST and surgically removed, while the 5 hypoenhanced lesions emerged to be 1 lipoma and 4 leiomyoma. In 2 out of 5 patients presenting with a GIST a bleeding complication appeared following submucosal tissue sampling requiring endoscopic treatment. Conclusion: CEHEUS in our hands could discriminate GIST from benign lesions with good accuracy in this small set of patients. If these results can be confirmed in a larger patient population the following treatment algorithm might be applied: Gastric wall lesion with hyperenhancement can be send directly for resection without prior biopsy sampling, hypoenhanced solid lesions can either be further classified by tissue sampling or just controlled by endosonography during follow-up.
Tu1154 Colonic Darkness: Seeing in a New Light? James Cullis, Ramesh P. Arasaradnam, Nigel R. Williams, Karna D. Bardhan, Adrian Wilson Introduction We observed by chance that PET scans showed areas of darkness in the colon, signifying uptake of the radiopharmaceutical 18F-fluoro-deoxy glucose (FDG). The phenomenon is well recognised by radiologists who accept this as an occasional background event but it is regarded as without significance. This pilot investigation assessed how frequent FDG uptake is observed in the colon, and its anatomical distribution. Methods 30 patients investigated by PET-CT for head and neck tumours were selected at random from patients studied over the past three years provided the reports referred to either “no abdominal abnormality” or “normal physiological uptake”. Five observers independently scored uptake using a visual analogue scale from 0-5, where in each patient 5 was assigned to the segment with the maximum uptake, i.e. the score was normalised to an individual rather than to the whole cohort. Scores were generated for 4 segments: caecum (C) + ascending colon (AC); transverse colon (TC); descending colon (DC); sigmoid and rectum (SR). Where no uptake was apparent anywhere, all segments were scored 0. Quantitative analysis in a subset of 10 was done to determine uptake in each segment. This was expressed as a percentage of total colonic uptake, both with and without normalisation to segmental length. Results 1. Qualitative analysis showed differences in uptake scores between the segments, with DC and C+AC having the highest uptake. 2. All observers commented on the high incidence
S-753
AGA Abstracts
AGA Abstracts
Contrast Enhanced Endoscopic Ultrasound Helps Distinguish Pancreatic Adenocarcinoma From Other Malignant Pancreatic Lesions Klaus Kannengiesser, Reiner Mahlke, Frauke Petersen, Torsten F. Kucharzik, Christian Maaser
Tu1152
Endoscopic ultrasound (EUS) has become a standard diagnostic tool for staging pancreatic lesions. As hypoechogenicity is not a soul sign of pancreatic adenocarcinoma but e.g. is also seen for neuroendocrine carcinoma as well as for metastasis one usually has to perform EUS-guided fine needle aspiration with all its limitations in order to decide which form of treatment to choose. Contrast enhanced ultrasound has been used for several years in transabdominal ultrasound and proofed to be effective in discriminating different lesions especially in the liver looking at the blood perfusion characteristics. As with the newest generation of endoscopic ultrasound machines contrast enhanced harmonic endoscopic ultrasound (CEH-EUS) has become a new option the aim of our study was to evaluate whether CEH-EUS may help to discriminate pancreatic adenocarcinoma from other malignant and non-malignant pancreatic lesions. Methods: Twenty consecutive patients with suspicious pancreatic lesions where investigated with CEH-EUS after standard EUS procedures. Patients received intravenously 5 ml contrast agent (SonoVue, Bracco, Inc.) followed by a 10 ml saline flush. Ultrasound sequences were documented as a video file and perfusion characteristics determined immediately after investigation. Time intensity curves were calculated and compared to areas of normal appearing pancreatic tissue in the same individual. Samples from EUS-fine needle aspirates of the suspicious lesions or surgical resections, where applicable, served as gold standard. Results: CEH-EUS showed 12 lesions with reduced contrast enhancement (intensity 8±4db), 8 lesions showed up hyper- or isoenhanced. 8 pancreatic adenocarcinomas, proven by histology, showed up hypoenhanced. Hyperenhanced lesions (n=5, intensity 48±7db) included 3 neuroendocrine carinomas, 1 metastasis of a renal cell carcinoma and 1 lymphoma. Sensitivity regarding pancreatic adenocarcinomas was 100%, specificity 75%. In 4 patients with chronic pancreatitis, chronic inflammatory masses showed up with reduced contrast enhancement, while 3 showed up isoenhanced. No malignancies in patients with chronic pancreatitis were detected in this set of patients. Conclusion: CE-EUS has shown to be helpful in the evaluation of suspicious pancreatic masses clearly differentiating between pancreatic adenocarcinoma versus neuroendocrine/metastatic lesions. We therefore suggest the following algorithm: An endosonographic hypoenhanced hypoechogenic pancreatic lesion in otherwise normal appearing pancreatic tissue without contraindication for surgery can be send for surgical therapy without prior histological evaluation while lesions showing hyperenhancement during CE-EUS should be further evaluated e.g. by EUS-fine needle aspiration.
Fluoroscopy of strictured esophagus.
Tu1153 I-Scan Technology is Useful to Improve the Rate of Gastric Varices Diagnosis in Patients With Portal Hypertension Lucia Sparano, Gianluca Ianiro, Marialuisa Novi, Immacolata A. Cazzato, Antonio Gasbarrini, Giovanni Cammarota BACKGROUND Gastric varices (GVs) are common in patients with portal hypertension and gastric variceal bleeding is associated with high mortality and morbidity rates. GVs may appear similar to enlarged gastric folds and submucosal lesions at standard endoscopy. A simple endoscopic method to diagnose GVs could be clinically useful. I-scan technology (IST) from PENTAX is a newly developed endoscopic tool that utilizes a digital contrast method to enhance endoscopic image in real time. MATERIALS AND METHODS Forty-three patients with documented history of portal hypertension, prospectively recruited, underwent upper endoscopy for evaluation of esophageal and gastric varices. All examinations were performed by a single endoscopist with high experience in the standard evaluation of esophageal and gastric varices and in the use of I-ST for the assessment of esophageal varices. Each patient was evaluated, during endoscopy, by using standard view before switching to I-ST . RESULTS Standard endoscopy revealed the presence of GVs in 4 patients of 43 (9,3%). Using I-ST, GVs were detected in 12 patients of 43 (27,9%). The four cases of GVs diagnosis at standard endoscopy were confirmed by I-ST. CONCLUSIONS Our results demonstrate that I-ST is a simple and useful method able to significantly improve the rate of GVs diagnosis in patients with portal hypertension. However, more investigations are necessary in a larger number of subjects to confirm these preliminary results and to determine the real clinical utility of this technology.
Esophageal patency achieved after CARD. A view from the stomach. Tu1151 Contrast Enhanced Endoscopic Ultrasound is a Helpful Tool to Differentiate Gastrointestinal Stromatumors From Benign Lesions Klaus Kannengiesser, Reiner Mahlke, Frauke Petersen, Torsten F. Kucharzik, Christian Maaser Since its introduction endoscopic ultrasound (EUS) has shown to be a helpful tool in endoscopic diagnostics, allowing precise detection of not only pancreatic masses, but also evaluation of esophageal, gastric and biliary lesions, while differentiation of benign and malignant lesions remains difficult. Gastric lesions with suspicion of gastrointestinal stromatumors (GIST) or benign lesions like lipoma or leiomyoma can often not be accurately differentiated by just using endoscopic ultrasound therefore requiring tissue sampling from the submucosal tissue after needle insertion with the risk of bleeding side effects especially in GIST. Contrast enhanced ultrasound has been used for several years in transabdominal ultrasound and proofed to be effective in discriminating various lesions e.g. in the liver through their blood perfusion characteristics. As with the newest generation of endoscopic ultrasound machines contrast enhanced harmonic endoscopic ultrasound (CEH-EUS) has become a new option the aim of our study was to evaluate whether CEH-EUS may help to discriminate various gastric/esophageal lesions. Methods: 10 patients with suspicious gastric or esophageal lesions where investigated with CEH-EUS after standard EUS procedures. Patients received 5 ml contrast agent (SonoVue, Bracco, Inc.) followed by a 10 ml saline flush. Ultrasound sequences were documented as a video file and perfusion characteristics determined immediately after investigation. Samples from EUS-fine needle aspirates, biopsy samples from the submucosal tissue after needle cut or surgical specimen, where applicable, served as gold standard. Results: CEH-EUS showed 5 lesions with reduced contrast enhancement (maximum intensity 6 ± 4db) and 5 lesions with hyperenhancement (maximum intensity 50 ± 20db). The latter 5 lesions where all histological identified as GIST and surgically removed, while the 5 hypoenhanced lesions emerged to be 1 lipoma and 4 leiomyoma. In 2 out of 5 patients presenting with a GIST a bleeding complication appeared following submucosal tissue sampling requiring endoscopic treatment. Conclusion: CEHEUS in our hands could discriminate GIST from benign lesions with good accuracy in this small set of patients. If these results can be confirmed in a larger patient population the following treatment algorithm might be applied: Gastric wall lesion with hyperenhancement can be send directly for resection without prior biopsy sampling, hypoenhanced solid lesions can either be further classified by tissue sampling or just controlled by endosonography during follow-up.
Tu1154 Colonic Darkness: Seeing in a New Light? James Cullis, Ramesh P. Arasaradnam, Nigel R. Williams, Karna D. Bardhan, Adrian Wilson Introduction We observed by chance that PET scans showed areas of darkness in the colon, signifying uptake of the radiopharmaceutical 18F-fluoro-deoxy glucose (FDG). The phenomenon is well recognised by radiologists who accept this as an occasional background event but it is regarded as without significance. This pilot investigation assessed how frequent FDG uptake is observed in the colon, and its anatomical distribution. Methods 30 patients investigated by PET-CT for head and neck tumours were selected at random from patients studied over the past three years provided the reports referred to either “no abdominal abnormality” or “normal physiological uptake”. Five observers independently scored uptake using a visual analogue scale from 0-5, where in each patient 5 was assigned to the segment with the maximum uptake, i.e. the score was normalised to an individual rather than to the whole cohort. Scores were generated for 4 segments: caecum (C) + ascending colon (AC); transverse colon (TC); descending colon (DC); sigmoid and rectum (SR). Where no uptake was apparent anywhere, all segments were scored 0. Quantitative analysis in a subset of 10 was done to determine uptake in each segment. This was expressed as a percentage of total colonic uptake, both with and without normalisation to segmental length. Results 1. Qualitative analysis showed differences in uptake scores between the segments, with DC and C+AC having the highest uptake. 2. All observers commented on the high incidence
S-753
AGA Abstracts
AGA Abstracts
Contrast Enhanced Endoscopic Ultrasound Helps Distinguish Pancreatic Adenocarcinoma From Other Malignant Pancreatic Lesions Klaus Kannengiesser, Reiner Mahlke, Frauke Petersen, Torsten F. Kucharzik, Christian Maaser