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Sa1545 Preprocedural Serum Carbohydrate Antigen CA 19-9 Levels and Diagnostic Outcomes in Pancreatic EUS Registry Patients
Abstracts
Sa1544 Serve a Juice Prior to EUS (Endoscopic Ultrasound) to Visualize Concealed Details of Pancreas Abdul Khaliq*1,2, Rakesh Kochhar2, Kartar Singh2 1 Gastroenterology and Hepatology, CARE, Hyderabad, India; 2 PGIMER, Chandigarh, India Introduction: Endoscopic ultrasound is useful to visualize pancreas. Sometimes pancreatic ductal details are not fully appreciable during EUS. Secretin is secreted by intestinal epithelial cells and stimulates exocrine pancreas to produce pancreatic juice causing temporary dilatation of pancreatic duct. Secretin is expensive limiting clinical utility. The orange-lemon juice stimulates exocrine pancreas nearly similar to intravenous secretin. Aim: To evaluate usefulness of orange-lemon juice prior to EUS for better visualization of pancreatic ductal changes. Methods: Prospective observational study. Patients with pancreatic diseases including recurrent acute pancreatitis (RAP), chronic pancreatitis (CP) and pancreatic space occupying lesions (SOL’s) and controls were enrolled. EUS was done, pancreatic changes including ductal changes and the diameter of pancreatic duct at a fixed point was noted. 200 ml of orange- lemon juice was served and EUS repeated after1 hour. Results: Of 24 cases, 10 were RAP, 6 were CP, 2 were pancreatic SOL’s and 6 were controls. Mean diameter of MPD was 2.092 ⫾1.912 mm and post juice increased to 3.108⫾ 2.29 mm. (P⫽0.00). On sub group analysis, the MPD increased from 1.26 ⫾ 0.21 mm to 1.84⫾ 0.33 mm in RAP (P⫽0.001) , 4.63⫾ 2.48 to 6.53 ⫾ 2.15 in CP (P⫽0.002). Side branches were better appreciated in 13/24(54.2%).In a case more number of intraductal stones appreciated. Diagnosis of incomplete divisum was made in a case after juice. Conclusions: Orange- lemon juice facilitated EUS of pancreas increases the pancreatic ductal diameter significantly and is useful in better appreciation of pancreatic ductal changes.
PRE AND POST JUICE PANCREATIC DUCT CHANGES IN A NORMAL PANCREAS
PRE AND POST JUICE PANCREATIC DUCT IN CHRONIC PANCREATITIS
Sa1545 Preprocedural Serum Carbohydrate Antigen CA 19-9 Levels and Diagnostic Outcomes in Pancreatic EUS Registry Patients Rana M. Khan*, Shiro Urayama Division of Gastroenterology & Hepatology, Department of Medicine, University of California, Davis, Sacramento, CA Background: The carbohydrate antigen (CA) 19-9 level is commonly utilized for evaluation of pancreaticobiliary malignant disorders. In recent reports, it is also being employed as a potential screening parameter in high-risk pancreatic cancer (PDAC)patients. Independently, however, it’s not considered as a single detection test for pancreatic cancer (PDAC) due to the false negativity encountered in early stage disease. Patients referred for EUS evaluation with suspected pancreatic cancer is commonly without metastatic lesion, this group as a whole would have a tendency to consist of earlier PDAC stages than general PDAC oncologic population. In this study, we investigated the pre-endoscopic ultrasound (EUS) CA 19-9 levels in our Pancreatic EUS Registry patients to correlate with the eventual diagnostic spectrum of this population. Methods: IRB approved UC Davis Pancreas EUS Registry data from 11/2002 to 11/2011 was retrospectively reviewed. We have gathered data from all patients with available
www.giejournal.org
pre-procedure CA19-9 and corresponding final diagnosis and PDAC stage information when applicable, based on cytopathological or clinical follow-up record. Clinical diagnostic outcomes for three CA19-9 classes were investigated: Normal (⬍37U/mL), Mild elevation (37 to 200U/mL), and Significant elevation (⬎200U/mL). Results: 283 patients including 148 of PDAC, 35 chronic pancreatitis (CP), 10 NET, 6 IPMN, 3 ampullary cancers, 5 mucinous cystadenomas, 3 cholangiocarcinomas, 2 serous cystadenomas 21 benign pancreatic cyst, 36 normal patients and 14 others organ lesions with documented CA19-9 value and final clinical diagnosis were reviewed. Demographically 78.8% patient were white with no significant gender difference. 127/283 (44.8%) patients had normal CA 19-9. 22.3 % (33/148) diagnosed PDAC patient has a normal CA 19-9. Only 30.5% (11/36) normal pancreas EUS patients and 28.5% (10/35) of CP patients has elevated CA 19-9 level as compared to PDAC patients 77.7% (113/148) p value ⬍0.001. The highest CA 19-9 in CP and normal pancreas was 861 and 610 respectively while in PDAC it was 424589 u/ml(stage III PDAC). 7/33 patients in the PDAC group with normal CA 19-9 has advance stage (III, IV). Conclusions: Among the EUS Registry patients referred for suspected pancreatic lesions with variable CA19-9 levels, we found the following: 1) Pre-procedural CA19-9 value of greater than 200 U/mL corresponded with high likelihood of eventual diagnosis of pancreaticobiliary carcinoma ( p valur⬍0.001). 2) Mild elevation of the CA19-9 was only suggestive of 50% diagnosis of pancreaticobiliary carcinoma. 3) There were a fair proportion of patients who had negative CA19-9, but who were eventually diagnosed with pancreaticobiliary carcinoma (33/148 PDAC patients)
Sa1546 Evaluation of 2 New EUS-Needles « PRO Core 21 and 20 Gauges » in Patients With Pancreatic Masses. Results of a Randomized Study Marc Giovannini*, Flora Poizat, Erwan Bories, Fabrice Caillol, Christian Pesenti, Genevieve M. Monges, Jean Luc Raoul Endoscopy, Paoli-Calmettes Institute, Marseille, France Aim: To evaluate a novel 20-G and 21-G histology EUS needle and to assess its diagnostic accuracy in patients with a solid pancreatic mass and to compare the histology and cytology finding with a 22-G procore needle. Patients and Methods: Fifteen consecutive patients with a solid pancreatic mass were enrolled in this prospective randomized study. Patients underwent EUS examination using a convex array echoendoscope which was connected to an ultrasound processor. EUS fine needle biopsy (FNB) was performed with a newly developed 22-G ProCore needle from Cook Medical Inc, for the 15 patients and a second EUSFNB was performed using a 20-G or 21-G following a randomization 1/1. Technique: After the lesion was penetrated the stylet was removed and suction was applied for 10 to 20 seconds using a 10 mL syringe while moving the needle to and fro one to four times. Only a single pass was performed. The specimen was recovered in cytolit and further processed for histological analysis. A final diagnosis of malignancy or benignancy was based on definite surgical pathology or clinical follow-up including repeated imaging examinations.Specimen were evaluated by 2 experienced pathologists and a score was applied for the presence of a microcore (0 or 1), for the cellularity of the core (good⫽2, mild⫽1 poor⫽0), for the cellularity of the monolayer technique (good⫽2, mild⫽1 poor⫽0). Results: No complication occurred during the study. A total of 15 patients (8M & 7F, mean age 59.2 years, range 34-80) with a solid pancreatic mass were enrolled. Lesions were located in the uncinate process (3 cases), in the head (12 cases). Mean size of the pancreatic masses was 25 mm (range 13-35 mm). Final diagnosis was Pancreatic adenoCa (10 cases), NET (3 cases), nodule of chronic pancreatitis (2 cases). Core biopsies were obtained in 11/15 cases (73.3%) using the 22-G needle and in 15/15 (100%) using the 20 or 21-G needle (p⬍ 0.002), score of cellularity was higher using the 20 or 21-G needle ( score⫽16) vs the 22-G needle (score⫽4, p⬍0.001). Regarding the cytology obtained with the monolayer, no difference was found between the different needles. Sensitivity, specificity, and accuracy for the histologic diagnostic of a pancreatic mass using the 22G ProCore needle were 50%, 100%, and 53.4%, respectively. Sensitivity, specificity, and accuracy for the histologic diagnostic of a pancreatic mass using the 20-G and 21-G ProCore needle were 92.3%, 100%, and 93.0%, respectively (p⬍ 0.001). No difference also was showed between 21G and 20-G needle in this study (21-G accuracy ⫽85.7% vs 20-G accuracy⫽87.5%). Conclusion: In this short randomized study, 20-G and 21-G EUS-needles appeared superior to the 22-G procore needle with an higher accuracy for the histologic diagnosis of a pancreatic mass.
Sa1547 EUS Versus ERC in Patients With Moderate Risk of Common Bile Duct Stones Rajesh Puri*, Randhir Sud, Ragesh B. Thandassery Institute of Digestive & hepatobiliary sciences, Medanta, The Medicity, Gurgaon, India Background: Endoscopic ultrasound (EUS) prior to endoscopic retrograde
Volume 75, No. 4S : 2012
GASTROINTESTINAL ENDOSCOPY
AB197
Sa1544 Serve a Juice Prior to EUS (Endoscopic Ultrasound) to Visualize Concealed Details of Pancreas Abdul Khaliq*1,2, Rakesh Kochhar2, Kartar Singh2 1 Gastroenterology and Hepatology, CARE, Hyderabad, India; 2 PGIMER, Chandigarh, India Introduction: Endoscopic ultrasound is useful to visualize pancreas. Sometimes pancreatic ductal details are not fully appreciable during EUS. Secretin is secreted by intestinal epithelial cells and stimulates exocrine pancreas to produce pancreatic juice causing temporary dilatation of pancreatic duct. Secretin is expensive limiting clinical utility. The orange-lemon juice stimulates exocrine pancreas nearly similar to intravenous secretin. Aim: To evaluate usefulness of orange-lemon juice prior to EUS for better visualization of pancreatic ductal changes. Methods: Prospective observational study. Patients with pancreatic diseases including recurrent acute pancreatitis (RAP), chronic pancreatitis (CP) and pancreatic space occupying lesions (SOL’s) and controls were enrolled. EUS was done, pancreatic changes including ductal changes and the diameter of pancreatic duct at a fixed point was noted. 200 ml of orange- lemon juice was served and EUS repeated after1 hour. Results: Of 24 cases, 10 were RAP, 6 were CP, 2 were pancreatic SOL’s and 6 were controls. Mean diameter of MPD was 2.092 ⫾1.912 mm and post juice increased to 3.108⫾ 2.29 mm. (P⫽0.00). On sub group analysis, the MPD increased from 1.26 ⫾ 0.21 mm to 1.84⫾ 0.33 mm in RAP (P⫽0.001) , 4.63⫾ 2.48 to 6.53 ⫾ 2.15 in CP (P⫽0.002). Side branches were better appreciated in 13/24(54.2%).In a case more number of intraductal stones appreciated. Diagnosis of incomplete divisum was made in a case after juice. Conclusions: Orange- lemon juice facilitated EUS of pancreas increases the pancreatic ductal diameter significantly and is useful in better appreciation of pancreatic ductal changes.
PRE AND POST JUICE PANCREATIC DUCT CHANGES IN A NORMAL PANCREAS
PRE AND POST JUICE PANCREATIC DUCT IN CHRONIC PANCREATITIS
Sa1545 Preprocedural Serum Carbohydrate Antigen CA 19-9 Levels and Diagnostic Outcomes in Pancreatic EUS Registry Patients Rana M. Khan*, Shiro Urayama Division of Gastroenterology & Hepatology, Department of Medicine, University of California, Davis, Sacramento, CA Background: The carbohydrate antigen (CA) 19-9 level is commonly utilized for evaluation of pancreaticobiliary malignant disorders. In recent reports, it is also being employed as a potential screening parameter in high-risk pancreatic cancer (PDAC)patients. Independently, however, it’s not considered as a single detection test for pancreatic cancer (PDAC) due to the false negativity encountered in early stage disease. Patients referred for EUS evaluation with suspected pancreatic cancer is commonly without metastatic lesion, this group as a whole would have a tendency to consist of earlier PDAC stages than general PDAC oncologic population. In this study, we investigated the pre-endoscopic ultrasound (EUS) CA 19-9 levels in our Pancreatic EUS Registry patients to correlate with the eventual diagnostic spectrum of this population. Methods: IRB approved UC Davis Pancreas EUS Registry data from 11/2002 to 11/2011 was retrospectively reviewed. We have gathered data from all patients with available
www.giejournal.org
pre-procedure CA19-9 and corresponding final diagnosis and PDAC stage information when applicable, based on cytopathological or clinical follow-up record. Clinical diagnostic outcomes for three CA19-9 classes were investigated: Normal (⬍37U/mL), Mild elevation (37 to 200U/mL), and Significant elevation (⬎200U/mL). Results: 283 patients including 148 of PDAC, 35 chronic pancreatitis (CP), 10 NET, 6 IPMN, 3 ampullary cancers, 5 mucinous cystadenomas, 3 cholangiocarcinomas, 2 serous cystadenomas 21 benign pancreatic cyst, 36 normal patients and 14 others organ lesions with documented CA19-9 value and final clinical diagnosis were reviewed. Demographically 78.8% patient were white with no significant gender difference. 127/283 (44.8%) patients had normal CA 19-9. 22.3 % (33/148) diagnosed PDAC patient has a normal CA 19-9. Only 30.5% (11/36) normal pancreas EUS patients and 28.5% (10/35) of CP patients has elevated CA 19-9 level as compared to PDAC patients 77.7% (113/148) p value ⬍0.001. The highest CA 19-9 in CP and normal pancreas was 861 and 610 respectively while in PDAC it was 424589 u/ml(stage III PDAC). 7/33 patients in the PDAC group with normal CA 19-9 has advance stage (III, IV). Conclusions: Among the EUS Registry patients referred for suspected pancreatic lesions with variable CA19-9 levels, we found the following: 1) Pre-procedural CA19-9 value of greater than 200 U/mL corresponded with high likelihood of eventual diagnosis of pancreaticobiliary carcinoma ( p valur⬍0.001). 2) Mild elevation of the CA19-9 was only suggestive of 50% diagnosis of pancreaticobiliary carcinoma. 3) There were a fair proportion of patients who had negative CA19-9, but who were eventually diagnosed with pancreaticobiliary carcinoma (33/148 PDAC patients)
Sa1546 Evaluation of 2 New EUS-Needles « PRO Core 21 and 20 Gauges » in Patients With Pancreatic Masses. Results of a Randomized Study Marc Giovannini*, Flora Poizat, Erwan Bories, Fabrice Caillol, Christian Pesenti, Genevieve M. Monges, Jean Luc Raoul Endoscopy, Paoli-Calmettes Institute, Marseille, France Aim: To evaluate a novel 20-G and 21-G histology EUS needle and to assess its diagnostic accuracy in patients with a solid pancreatic mass and to compare the histology and cytology finding with a 22-G procore needle. Patients and Methods: Fifteen consecutive patients with a solid pancreatic mass were enrolled in this prospective randomized study. Patients underwent EUS examination using a convex array echoendoscope which was connected to an ultrasound processor. EUS fine needle biopsy (FNB) was performed with a newly developed 22-G ProCore needle from Cook Medical Inc, for the 15 patients and a second EUSFNB was performed using a 20-G or 21-G following a randomization 1/1. Technique: After the lesion was penetrated the stylet was removed and suction was applied for 10 to 20 seconds using a 10 mL syringe while moving the needle to and fro one to four times. Only a single pass was performed. The specimen was recovered in cytolit and further processed for histological analysis. A final diagnosis of malignancy or benignancy was based on definite surgical pathology or clinical follow-up including repeated imaging examinations.Specimen were evaluated by 2 experienced pathologists and a score was applied for the presence of a microcore (0 or 1), for the cellularity of the core (good⫽2, mild⫽1 poor⫽0), for the cellularity of the monolayer technique (good⫽2, mild⫽1 poor⫽0). Results: No complication occurred during the study. A total of 15 patients (8M & 7F, mean age 59.2 years, range 34-80) with a solid pancreatic mass were enrolled. Lesions were located in the uncinate process (3 cases), in the head (12 cases). Mean size of the pancreatic masses was 25 mm (range 13-35 mm). Final diagnosis was Pancreatic adenoCa (10 cases), NET (3 cases), nodule of chronic pancreatitis (2 cases). Core biopsies were obtained in 11/15 cases (73.3%) using the 22-G needle and in 15/15 (100%) using the 20 or 21-G needle (p⬍ 0.002), score of cellularity was higher using the 20 or 21-G needle ( score⫽16) vs the 22-G needle (score⫽4, p⬍0.001). Regarding the cytology obtained with the monolayer, no difference was found between the different needles. Sensitivity, specificity, and accuracy for the histologic diagnostic of a pancreatic mass using the 22G ProCore needle were 50%, 100%, and 53.4%, respectively. Sensitivity, specificity, and accuracy for the histologic diagnostic of a pancreatic mass using the 20-G and 21-G ProCore needle were 92.3%, 100%, and 93.0%, respectively (p⬍ 0.001). No difference also was showed between 21G and 20-G needle in this study (21-G accuracy ⫽85.7% vs 20-G accuracy⫽87.5%). Conclusion: In this short randomized study, 20-G and 21-G EUS-needles appeared superior to the 22-G procore needle with an higher accuracy for the histologic diagnosis of a pancreatic mass.
Sa1547 EUS Versus ERC in Patients With Moderate Risk of Common Bile Duct Stones Rajesh Puri*, Randhir Sud, Ragesh B. Thandassery Institute of Digestive & hepatobiliary sciences, Medanta, The Medicity, Gurgaon, India Background: Endoscopic ultrasound (EUS) prior to endoscopic retrograde
Volume 75, No. 4S : 2012
GASTROINTESTINAL ENDOSCOPY
AB197