Value of endoscopic ultrasonography (EUS) in the diagnosis of cystic dystrophy of the duodenal wall associated with chronic pancreatitis

Abstracts

15

13 The endoscopic treatment of gastroesophagcal bleeding caused by oesophageal vatices breakage. Roman0 Gi, Air6 Fandla h4, Gambino GL, Agrusa 4 Parrinello M, Lo Nigro R, L-#&a F. Department of General ad Transplantation Surgery (Dir. Prof. Maurizio Romano)University of Palermo Aims: Gastrcesophageal variceal bleeding is a major complication of portal hypertension and is considered a life-threatening emergency; for this reason a prompt and specific intervention are essential to stop the bleeding. Endoscopic intervention is the <> therapy and should be employed at de first line to control actually bleeding. Methods: In our department we have considered a report of 53 consecutive patients with esophageal variceal bleeding caused by advanced cirrhosis from March 1994 to December 1999. In tive patients with a too vigorous bleeding we employed balloon tamponade with a triple. lumen (Sengstaken-Blakemore) tube with oesophageal and gastric balloons. Two of these patients, successively, underwent to endoscopic legation of varices. 48 patients (90.4%) 21 males and 27 females (mean age 61 years) underwent to early diagnostic endoscopy evaluation with flexible videoscopy by the beginning. I” 3 cases no haemostatic intervention was necessary because of spontaneous stop of haunorrhage; in 45 cases (84.9%) endoscopic diagnosis was followed by the sclerosis of bleeding varices. In 8 patients (17.8%) the bleeding was tirst episode, whole in the remnant (82.2%) was recurrent. In 37 patients we observed F3 classified varices and in 6 we also found variccs in gastric bottom. To obtain homeostasis we used 1% polidocanolo in 41 cases (91.1%) and butilvcianoacrylate in 4 patients. Resultc: In 43 cases we attained a good control of haemorrhage. In 2 patients, because of an early relapse (< 12h), we performed a new endoseopic procedure using an acrylic glue. The most frequent complication was the oesophageus ulcer that we found in 4 cases and in only I case we caused a perforation. Conclusions: Over the past 15 years, endoswpic control of variceal bleeding has been extensively employed. After endoscopic identification of varices as the presumed source of bleeding, sclerotherapy and, more recently, endoswpic rubber bleeding of varices control acute bleeding in up to 80 percent of cases.

CONTRIBUTION OF ENDOSONOGRAPEN DIAGNOSIS OF DUODENAL DUPLICATION REPORTS.

(EUS) TO TEE IN ADULTS: CASE

w, Pas&ato N., ‘Falconi M., Mnnfi+i C., Be”edetti S., Battcccbia A Divisione di Oastroertterolo8ia ed Endoscscopia Digestiva , Ospedale Ciie Maggiorr Verona. ‘Dipardmento di Scienre Chimrgiche, Poiiclinico, VerOna Backaround: Duodenal duplicatio”s (DD) are rare co”ge”ital malt&matio”s (412% of all intestinal du&&o”s). ‘&,.xa,ly they are discwere‘, duri”a ;he neonatal period or infancy. i adult patients they are unca”m& Duplicatio”s can aw.“ne either a spherical or a tubular shape alId they share a cornm~n muscle layer with the parent duodenum. The diagnosis cd” be made hy Ultrasono~hy (US) or Computed Tomography (CT) but sometimes it is very diEcult. Endosanqraphy @US) has been used in a fw instsnces. a: To describe the EUS features of DD and highlight the diagnostic e&ctivrness of this “I&cd, reviewing our experience in i-w0 ca?es. Case Rewtts: u A t&tee” year-old male pa&t with a history of recurrm epigawic pain and episodic vo*g, asscciafed with a mild inof serum amylaw alId lipases. The fo8owiq diagnostic ima&& methcds (with related diagnoses) were performed: us (pancreatic psa~Iocys&); Dwdencsqy (suspected inaahuninal divexticulum or DD); CT @D). Subsequmtly EUS was perfomud. This examir&o” revealed the prese”ce of a” rmechoic (cystic) tity, of about 5 cm in diameter, stemmiq fium the second dwdemnn The cyst was separated from the proper duodenum by a septum, correqondiog to the duodenal wall, on the comer of which the mucosai @yp&oic) and submucosal (hyperechcic) layers appeared to be duplicated Co”seque”tly, the in”er li”iag of the cyst consisted of these two layers. On the outside borders there was a smooth muscle waU (hypwchoic), contirmous with the proper muscle layers of the duodemun. These findings are typical of DD. Case N”?: A 39 yeardid female pa&t witi recurrent attacks of acute pawxatitis. The diagwis madebyUSandCTwasofpseudocysto”afirstlookandofDDcna second look. EUS examination folmd a cysfic lesion of the seccnd portico and gem inferior of the duodenum with the same features as case WI. The uatients had scraical marsuoiulizatio” of the enteric cysts The histolow_. of ;he sur8ica.l bicp-y co”tim&l the diagnosis ofDD Condusion~: I) EZUSDD features are typical and easy to di&re”tiate Tom pancreatic pseudocysts and cystic dystrophy of the duodenal wall. (2) EUS is therefore very useful to co&m or exclude this diagnosis.

14 VALUE OF ENDOSCOPIC ULTRASONOGRAPRY (EUS) IN TRE DIAGNOSIS OF CYSTIC DYSTROPHY OF TEE DUODENAL WALL ASSOCIATED WITE CHRONIC PANCREATITIS &i&4, Pass&to N., Ma”6ini C., Ze&i”ato 0.. Battccchia A Divisions cU nlogia ed Endoscqia Digestim OspedaIe Civile Maggiore - Verona BACKrROm Cystic dystrophy of the duode”al wall (CD) is a rare dkea.so chamctexised by the prcse”ce of heterctopic pancreatic tisue and cysts, sulmundd by chronic btaa”lmati0” and 53rosis. CD is classified as eitba cystic or solid in fype. The disease is ofim associMed with variable forms of ctmmic panereatitis. The diagnosis is mainly bawd on pathclogical find+ atbr pancreatoduodeosctcmy (I’D). E”dcso”qaphy @US) can be considered = a us&id and reliable mahod of detect& CD PATIENTS AND METBpBs from May 1993 to Februmy ZOOO.23 male padents (average age 45 y&, range 14-65) were submitted to EUS i”veai&on of the pa”crea3 for a better d&&ion of thdr disease. The majority of them (18) were a&ted by chronic pmcrwitis (CP) or cbmnic calcitied pa”crcatitis (CCP) titb acute attacks. R&psi”8 abdominalpai4vomiting,aauscaandwdghtlosswcrrthcmaiasymptoms. Jn au the patients, prior tc EUS, abdcmillal echography (US) as we8 a¶ cmQuted tomoglaphy (CT) were paformed. Three bad magnetic Iwmance @fluI and IS mdoscopic psttmstogTaphy (ERCP). These otha inuging tech”iqlles @IT) and Em l-eshd in the foUowi”8 diag”0s.x 1) CD with CP or CCP (OTT: 10, EUS: 15): 2) CP or CCP with or without pseu&qsm PIT: 8,EUS: 8); 3) Duodemd duplicatio” (01~2, EUS: 0): 4) Panueatic tumor (OIT: 3. EUS: 0). Biightkn pad- bad wrgexy. 16 uderwem PD snci 2 Wuoung-JejuwJ ansstomosis (WJa). 5 patie”ts sre b&g f&wed-up RESULTS:CD,withCPorCCP,wa.foundinall~atients~to~~

pancreatic tumcm and duode”al d&i&m In & 2 patients who had WJa and in the 5 followed-up, all a&ted ty CF’ or CCP, the EUS findings were sfro”gly suggmive of CD i” six of them. MNCLUSIONS: EUS can be co”sidered u a very us&d and reliable sin@e test for the detection of CD, especially of classic cystic type. Futhennore it allows the differe”tial diagnosis of CD BSagainsr pseudocysts, duodenalduplications md pancreatic “eoplasms.

Hcc PREVALENCE AM) ULTR.~S~NOGRAPHIC PA~ERN IN A SICILL4N~POPULATION A.Broans S.Trw&“, A.M.Bucceri’, E. Lanter?, A.Cantw&, M. Loreno’:A. Blasi’, F.Cat&mo’. Chair of Patbophysiology’, Chair of General Pathophysiolo&, Institute of Internal Medicine ‘A. Frawaviglia”, Institute of General Pathology’, Gastroentemlogy and Endoscopy U-hit’- University of C!ata”ia Italy. Backamund aad atm. He”atcccUti carcinoma IHCC) ~ , is one oftbe most ctmmon cause of cancer death in Europe. The prognosis of HCC patients is poor and early detection with real-time ultrasound is a” urgent subject in cunical medicine. we have smkd the prevalence and the uhra.wwgraphic “attern of HCC in 7,634 Sicilian outcatients underaoinn - - abdominal ultraReaslts. Distriiution by sex and age of 70 HCC detected by ultrasound and confnmed bv histolonv is shown in table below. Focal lesions were classified as mono-nod&-won), uhui-nodular (Phu) and diffusely i”tiltrati”8

ter of lesions were evaluated. Hypoechoic halo was found in 45 patients (64%); the echographic pattern was isoechoic in 27, hypoechoic in 18, hyperechoic in 17, diwmogenous io 20 patients. Regardin lesions’ diisions, 14 lesions were less than 2 cm 35 were 2-4 cm and 33 were more than 4 cm in diameter. Conclusions. The higher prevalence of singular lesions is evidenced in femaks who never show ditliwly infileating lesiotls in cw series.