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Shaaban HE, Abdellatef A, Okasha HH. Hepatic recompensation according to Baveno VII criteria via transjugular intrahepatic portosystemic shunt. World J Gastroenterol 2024; 30:1777-1779. [PMID: 38617737 PMCID: PMC11008372 DOI: 10.3748/wjg.v30.i12.1777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/30/2023] [Accepted: 02/20/2024] [Indexed: 03/28/2024] Open
Abstract
Transjugular intrahepatic portosystemic shunt is a therapeutic modality done through interventional radiology. It is aimed to decrease portal pressure in special situations for patients with decompensated liver disease with portal hypertension. It represents a potential addition to the therapeutic modalities that could achieve hepatic recompensation in those patients based on Baveno VII criteria.
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Affiliation(s)
- Hossam Eldin Shaaban
- Department of Internal Medicine and Gastroenterology, NHTMRI, Cairo 11796, Egypt
| | - Abeer Abdellatef
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11562, Egypt
| | - Hussein Hassan Okasha
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11562, Egypt
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Gadour E, Awad A, Hassan Z, Shrwani KJ, Miutescu B, Okasha HH. Diagnostic and therapeutic role of endoscopic ultrasound in liver diseases: A systematic review and meta-analysis. World J Gastroenterol 2024; 30:742-758. [PMID: 38515947 PMCID: PMC10950627 DOI: 10.3748/wjg.v30.i7.742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/19/2023] [Accepted: 01/16/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND In hepatology, the clinical use of endoscopic ultrasound (EUS) has experienced a notable increase in recent times. These applications range from the diagnosis to the treatment of various liver diseases. Therefore, this systematic review summarizes the evidence for the diagnostic and therapeutic roles of EUS in liver diseases. AIM To examine and summarize the current available evidence of the possible roles of the EUS in making a suitable diagnosis in liver diseases as well as the therapeutic accuracy and efficacy. METHODS PubMed, Medline, Cochrane Library, Web of Science, and Google Scholar databases were extensively searched until October 2023. The methodological quality of the eligible articles was assessed using the Newcastle-Ottawa scale or Cochrane Risk of Bias tool. In addition, statistical analyses were performed using the Comprehensive Meta-Analysis software. RESULTS Overall, 45 articles on EUS were included (28 on diagnostic role and 17 on therapeutic role). Pooled analysis demonstrated that EUS diagnostic tests had an accuracy of 92.4% for focal liver lesions (FLL) and 96.6% for parenchymal liver diseases. EUS-guided liver biopsies with either fine needle aspiration or fine needle biopsy had low complication rates when sampling FLL and parenchymal liver diseases (3.1% and 8.7%, respectively). Analysis of data from four studies showed that EUS-guided liver abscess had high clinical (90.7%) and technical success (90.7%) without significant complications. Similarly, EUS-guided interventions for the treatment of gastric varices (GV) have high technical success (98%) and GV obliteration rate (84%) with few complications (15%) and rebleeding events (17%). CONCLUSION EUS in liver diseases is a promising technique with the potential to be considered a first-line therapeutic and diagnostic option in selected cases.
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Affiliation(s)
- Eyad Gadour
- Department of Gastroenterology and Hepatology, King Abdulaziz Hospital-National Guard, Ahsa 31982, Saudi Arabia
- Department of Internal Medicine, Faculty of Medicine, Zamzam University College, Khartoum 11113, Sudan
| | - Abeer Awad
- Department of Hepatogastroenterology, Kasar Alainy Hospital, Faculty of Medicine, Cairo University, Cairo 11451, Egypt
| | - Zeinab Hassan
- Department of Internal Medicine, Stockport Hospitals NHS Foundation Trust, Manchester SK2 7JE, United Kingdom
| | - Khalid Jebril Shrwani
- Public Health Authority, Saudi Center for Disease Prevention and Control, Jazan 45142, Saudi Arabia
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, School of Medicine and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Bogdan Miutescu
- Department of Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Timisoara 300041, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, Victor Babes University of Medicine and Pharmacy, Timisoara 30041, Romania
| | - Hussein Hassan Okasha
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11562, Egypt
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Okasha HH, Delsa H, Gobran BA, Nakhla R. Fasciola hepatica: an unusual cause of biliary obstruction. Gastrointest Endosc 2023; 98:660-661. [PMID: 37364704 DOI: 10.1016/j.gie.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 12/28/2022] [Accepted: 06/21/2023] [Indexed: 06/28/2023]
Affiliation(s)
- Hussein Hassan Okasha
- Division of Gastroenterology, Hepatology, and Endoscopy, Internal Medicine Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Hanane Delsa
- Department of Gastroenterology and Hepatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health and Sciences, Casablanca, and Research Entity, Mohammed VI Center for Research & Innovation, Rabat, Morocco
| | - Bassem Amin Gobran
- Gastroenterology and Hepatology, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
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Okasha HH, Delsa H, Alsawaf A, Hashim AM, Khattab HM, Abdelfatah D, Abdellatef A, Albitar A. Role of endoscopic ultrasound and endoscopic ultrasound-guided tissue acquisition in diagnosing hepatic focal lesions. World J Methodol 2023; 13:287-295. [PMID: 37771875 PMCID: PMC10523253 DOI: 10.5662/wjm.v13.i4.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/23/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Endoscopic ultrasonography (EUS) has become an established method in diagnostic and therapeutic procedures in gastroenterology; however, it has recently gained a growing role in hepatology. AIM To evaluate the role of EUS features, strain elastography (SE), and EUS-tissue acquisition in diagnosing hepatic focal lesions (HFLs) that could affect further management. METHODS This cross-sectional study included 215 patients with pancreatic, biliary, or gastrointestinal malignancies referred for EUS examination. HFLs were identified in 43 patients (20%), and EUS-guided tissue acquisition was performed from these lesions. RESULTS EUS features were highly sensitive (100%) but much less specific (57%) in diagnosing HFLs; the overall accuracy was 94%. Real-time elastography was also very sensitive (97%) but less specific (67%) in diagnosing HFLs; however, the overall accuracy was 92%. EUS tissue acquisition was extremely sensitive (100%) and specific (100%), with a 100% overall diagnostic accuracy. CONCLUSION The diagnostic utility of EUS-guided tissue acquisition was extremely accurate in diagnosing HFLs. EUS characteristics and real-time SE accurately predicted the histological diagnosis of both benign and malignant HFLs.
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Affiliation(s)
- Hussein Hassan Okasha
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11451, Egypt
| | - Hanane Delsa
- Department of Gastroenterology and Hepatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Casablanca 82403, Morocco
- Research Unit, Mohammed VI Center for Research and Innovation, Rabat 10100, Morocco
| | - Abdelmoneim Alsawaf
- Department of Gastroenterology, Barnsley NHS Foundation Trust, Barnsley S75 2EP, United Kingdom
| | - Ahmed Morad Hashim
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11451, Egypt
| | - Hani M Khattab
- Department of Pathology, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11451, Egypt
| | - Dalia Abdelfatah
- Department of Cancer Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo 11451, Egypt
| | - Abeer Abdellatef
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11451, Egypt
| | - Amr Albitar
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Cairo University, Cairo 11451, Egypt
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Okasha HH, Gouda M, Tag-Adeen M, Farouk M, Alzamzamy A, Abou Elenin S, Pawlak KM, Awad A, Mohamed B. Clinical, Radiological, and Endoscopic Ultrasound Findings in Groove Pancreatitis: A Multicenter Retrospective Study. Turk J Gastroenterol 2023; 34:771-778. [PMID: 37403979 PMCID: PMC10441148 DOI: 10.5152/tjg.2023.22875] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/01/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND/AIMS Groove pancreatitis is a rare form of focal pancreatitis that affects the groove area. Since groove pancreatitis may be mistaken for malignancy, it should be considered in patients with pancreatic head mass lesions or duodenal stenosis to avoid unnecessary surgical procedures. The aim of the study was to document the clinical, radiologic, endoscopic characteristics, and treatment outcomes of patients with groove pancreatitis. MATERIALS AND METHODS This retrospective multicenter observational study included all patients diagnosed with one or more imaging criteria suggestive of groove pancreatitis in the participating centers. Patients with proven malignant fine-needle aspiration/biopsy results were excluded. All patients were followed in their own centers and were retrospectively evaluated. RESULTS Out of the initially included 30 patients with imaging criteria suggestive of groove pancreatitis, 9 patients (30%) were excluded because of malignant endoscopic ultrasound fine-needle aspiration or biopsy results. The mean age of the included 21 patients was 49 ± 10.6 years, with a male predominance of 71%. There was a history of smoking in 66.7% and alcohol consumption in 76.2% of patients. The main endoscopic finding was gastric outlet obstruction observed in 16 patients (76%). There was duodenal wall thickening in 9 (42.8%), 5 (23.8%), and 16 (76.2%) patients on computed tomography, magnetic resonance imaging, and endoscopic ultrasound, respectively. Moreover, pancreatic head enlargement/mass was observed in 10 (47.6%), 8 (38%), and 12 (57%) patients, and duodenal wall cysts in 5 (23.8%), 1 (4.8%), and 11 (52.4%) patients, respectively. Conservative and endoscopic treatment has achieved favorable outcomes in more than 90% of patients. CONCLUSIONS Groove pancreatitis should be considered in any case with duodenal stenosis, duodenal wall cysts, or thickening of the groove area. Various imaging modalities, including computerized tomography, endoscopic ultrasound, and magnetic resonance imaging, have a valuable role in characterizing groove pancreatitis. However, endoscopic fine-needle aspiration or biopsy should be considered in all cases to diagnose groove pancreatitis and exclude malignancy, which can have similar findings.
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Affiliation(s)
- Hussein Hassan Okasha
- Department of Internal Medicine and Hepatogastroenterology, Kasr Al-Aini School of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Gouda
- Theodor Bilharz Research Institute, Mouwasat Hospital Dammam, Giza, Egypt
| | - Mohammed Tag-Adeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, South Valley University Qena Faculty of Medicine, Egypt
| | - Mahmoud Farouk
- Department of Tropical Medicine and Gastroenterology, Assiut University, Assiut, Egypt
| | - Ahmed Alzamzamy
- Department of Internal Medicine and Gastroenterology, Maadi Armed Forces Medical Complex, Military Medical Academy, Cairo, Egypt
| | - Sameh Abou Elenin
- Department of Internal Medicine and Gastroenterology, Maadi Armed Forces Medical Complex, Military Medical Academy, Cairo, Egypt
| | - Katarzyna M. Pawlak
- Division of Internal Medicine, Department of Cardiology, Gastroenterology and Endocrinology, Endoscopy Unit of Hospital of the Ministry of Interior and Administration, Szczecin, Poland
| | - Abeer Awad
- Department of Internal Medicine and Hepatogastroenterology, Kasr Al-Aini School of Medicine, Cairo University, Cairo, Egypt
| | - Borahma Mohamed
- Division of Internal Medicine, Department of Cardiology, Gastroenterology and Endocrinology, Endoscopy Unit of Hospital of the Ministry of Interior and Administration, Szczecin, Poland
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Okasha HH, Mansor M, Sheriba N, Abdelfattah Y, Abdelfatah D, Orabi HE, Elebrashy IN, Saif A, Meligi AAE, Elshazli M, Elhadidy KE, Abushady MM, Islam EE, Yosef TM, Salama ASED, Ouf TI, Said SM, Eid YM, Mohsen AA, Rizk MN, Yousief E, Elrawi H, Ahmed TM, Roshdy E, Sedrak HK, Din HGE, Aboulsoud S, El-Sawy SS, El-Feki MA, Alzamzamy A, Elenin SA, Tag-Adeen M, Abdelhameed H, Awad A. Value of TI-RADS and elastography strain ratio in predicting malignant thyroid nodules: experience from a single center in Egypt. Egypt J Intern Med 2023; 35:45. [DOI: https:/doi.org/10.1186/s43162-023-00227-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/04/2023] [Indexed: 11/04/2023] Open
Abstract
Abstract
Introduction
Thyroid nodules are highly prevalent in the general population; therefore, it is crucial to discriminate benign from malignant nodules. A practical thyroid imaging reporting and data system (TI-RADS) for thyroid nodules and ultrasound elastography are valuable tools not only for characterization of nodules but also for the selection of tumors for fine-needle aspiration cytology (FNAC).
Objective
This study aimed to evaluate the diagnostic accuracy of US evaluation in the prediction of malignant thyroid nodules and evaluate the role of the elastography score, strain ratio (SR), and the TI-RADS scoring system as non-invasive tools in differentiation between malignant and benign thyroid nodules.
Material and methods
A total of 1269 patients were evaluated between February 2017 and April 2020 by a single expert thyroid ultrasound operator. The final diagnosis was achieved from cytological and/or histological evaluation and follow-up for at least 1 year.
Results
There were 1088 females and 181 males with a mean age of 44 ± 10 SD. The final diagnosis was 1197 benign nodules and 72 malignant nodules. Most malignant nodules were scored elastography score 4 (83.3%) and TI-RADS category 5 (86.11%). We found that nodules with antero-posterior to transverse (A-P/T) diameter > 1, have 21 times more risk to be malignant than those with A-P/T diameter < 1, patients with solitary thyroid nodules have 4.5 times to develop malignancy compared to those with multinodular goiter (MNG), nodules with absent halo have 4 times more risk of malignancy. Furthermore, microcalcifications in thyroid nodules increase the risk of malignancy 9 times compared to those without calcifications. SR was found to be an excellent discriminator to differentiate between benign and malignant nodules with P < 0.001. Also, we found that for every unit increase in SR, the risk of malignancy increased by 20%. We reported that the accuracy of ultrasonography in the detection of malignant thyroid nodules had a sensitivity of 89%, specificity of 98%, 70% PPV, and 99.3% NPV, with an overall accuracy of 97.2%.
Conclusion
The application of ultrasonographic non-invasive criteria for thyroid nodules in clinical practice might significantly reduce the number of unnecessary FNAC. Elastography, SR, and TI-RADS classification could be good predictors for malignant thyroid nodules.
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Pawlak KM, Tehami N, Maher B, Asif S, Rawal KK, Balaban DV, Tag-Adeen M, Ghalim F, Abbas WA, Ghoneem E, Ragab K, El-Ansary M, Kadir S, Amin S, Siau K, Wiechowska-Kozlowska A, Mönkemüller K, Abdelfatah D, Abdellatef A, Lakhtakia S, Okasha HH. Role of endoscopic ultrasound in the characterization of solid pseudopapillary neoplasm of the pancreas. World J Gastrointest Endosc 2023; 15:273-284. [PMID: 37138939 PMCID: PMC10150282 DOI: 10.4253/wjge.v15.i4.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/17/2023] [Accepted: 03/29/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Solid pseudopapillary neoplasm (SPN) is an uncommon pathology of the pancreas with unpredictable malignant potential. Endoscopic ultrasound (EUS) assessment plays a vital role in lesion characterization and confirmation of the tissue diagnosis. However, there is a paucity of data regarding the imaging assessment of these lesions.
AIM To determine the characteristic EUS features of SPN and define its role in preoperative assessment.
METHODS This was an international, multicenter, retrospective, observational study of prospective cohorts from 7 large hepatopancreaticobiliary centers. All cases with postoperative histology of SPN were included in the study. Data collected included clinical, biochemical, histological and EUS characteristics.
RESULTS One hundred and six patients with the diagnosis of SPN were included. The mean age was 26 years (range 9 to 70 years), with female predominance (89.6%). The most frequent clinical presentation was abdominal pain (80/106; 75.5%). The mean diameter of the lesion was 53.7 mm (range 15 to 130 mm), with the slight predominant location in the head of the pancreas (44/106; 41.5%). The majority of lesions presented with solid imaging features (59/106; 55.7%) although 33.0% (35/106) had mixed solid/cystic characteristics and 11.3% (12/106) had cystic morphology. Calcification was observed in only 4 (3.8%) cases. Main pancreatic duct dilation was uncommon, evident in only 2 cases (1.9%), whilst common bile duct dilation was observed in 5 (11.3%) cases. One patient demonstrated a double duct sign at presentation. Elastography and Doppler evaluation demonstrated inconsistent appearances with no emergence of a predictable pattern. EUS guided biopsy was performed using three different types of needles: Fine needle aspiration (67/106; 63.2%), fine needle biopsy (37/106; 34.9%), and Sonar Trucut (2/106; 1.9%). The diagnosis was conclusive in 103 (97.2%) cases. Ninety-seven patients were treated surgically (91.5%) and the post-surgical SPN diagnosis was confirmed in all cases. During the 2-year follow-up period, no recurrence was observed.
CONCLUSION SPN presented primarily as a solid lesion on endosonographic assessment. The lesion tended to be located in the head or body of the pancreas. There was no consistent characteristic pattern apparent on either elastography or Doppler assessment. Similarly SPN did not frequently cause stricture of the pancreatic duct or common bile duct. Importantly, we confirmed that EUS-guided biopsy was an efficient and safe diagnostic tool. The needle type used does not appear to have a significant impact on the diagnostic yield. Overall SPN remains a challenging diagnosis based on EUS imaging with no pathognomonic features. EUS guided biopsy remains the gold standard in establishing the diagnosis.
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Affiliation(s)
- Katarzyna M Pawlak
- Endoscopy Unit, Department of Gastroenterology, Hospital of The Ministry of Interior and Administration, Szczecin 01-218, Poland
| | - Nadeem Tehami
- Interventional Endoscopy Unit, University Hospital Southampton NHS Foundation Trust, 3AX PO, United Kingdom
| | - Ben Maher
- Interventional Endoscopy Unit, University Hospital Southampton NHS Foundation Trust, 3AX PO, United Kingdom
| | - Shujaath Asif
- Consultant Gastroenterologist, AIG Hospitals, Hyderabad 500032, India
| | - Krishn Kant Rawal
- Department of Gastroenterology, Prime Institute of Digestive Sciences, Rajkot 360001, India
| | - Daniel Vasile Balaban
- Department of Gastroenterology, Central Military Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest 010011, Romania
| | - Mohammed Tag-Adeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Qena Faculty of Medicine, South Valley University, Qena 83511, Egypt
- Department of Endoscopy, Shefa Al-Orman Hospital, Luxor 85951, Egypt
| | - Fahd Ghalim
- Interventional Endoscopy Unit, Sainte Marie Hospital, OSNY 95520, France
| | - Wael A Abbas
- Department of Internal Medicine, Gastroenterology Unit, Faculty of Medicine, Assuit University, Assuit 71511, Egypt
| | - Elsayed Ghoneem
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt
| | - Khaled Ragab
- Department of Hepatology and Gastroenterology, Theodor Bilharz Research Institute, Giza 12511, Egypt
| | - Mahmoud El-Ansary
- Department of Hepatology & Gastroenterology, Theodor Bilharz Research Institute, Giza 12511, Egypt
| | - Shanil Kadir
- Department of Gastroenterology, Liaquat National Hospital & Medical College, Karachi 75900, Pakistan
| | - Sunil Amin
- Division of Digestive and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 32118, United States
| | - Keith Siau
- Department of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, United Kingdom
| | | | - Klaus Mönkemüller
- Department of Gastroenterology, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, AL 35294, United States
| | - Dalia Abdelfatah
- Department of Cancer Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo 11511, Egypt
| | - Abeer Abdellatef
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Faculty of Medicine, Cairo University, Cairo 11511, Egypt
| | - Sundeep Lakhtakia
- Consultant Gastroenterologist, AIG Hospitals, Hyderabad 500032, India
| | - Hussein Hassan Okasha
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kasr Al-Aini School of Medicine, Faculty of Medicine, Cairo University, Cairo 11451, Egypt
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Delsa H, Bellahammou K, Okasha HH, Ghalim F. Cheesy material on macroscopic on-site evaluation after endoscopic ultrasound-guided fine-needle biopsy: Don't miss the tuberculosis. World J Clin Cases 2023; 11:2181-2188. [PMID: 37122512 PMCID: PMC10131024 DOI: 10.12998/wjcc.v11.i10.2181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/28/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is an excellent investigation to diagnose pancreatic lesions and has shown high accuracy for its use in pathologic diagnosis. Recently, macroscopic on-site evaluation (MOSE) performed by an endoscopist was introduced as an alternative to rapid on-site cytologic evaluation to increase the diagnostic yield of EUS-FNB. The MOSE of the biopsy can estimate the adequacy of the sample directly by the macroscopic evaluation of the core tissue obtained from EUS-FNB. Isolated pancreatic tuberculosis is extremely rare and difficult to diagnose because of its non-specific signs and symptoms. Therefore, this challenging diagnosis is based on endoscopy, imaging, and the bacteriological and histological examination of tissue biopsies. This uncommon presentation of tuberculosis can be revealed as pancreatic mass mimicking cancer. EUS-FNB can be very useful in providing a valuable histopathological diagnosis. A calcified lesion with a cheesy core in MOSE must be suggestive of tuberculosis, leading to the request of the GeneXpert, which can detect Mycobacterium tuberculosis deoxyribonucleic acid and resistance to rifampicin. A decent diagnostic strategy is crucial to prevent unnecessary surgical resection and to supply conservative management with antitubercular therapy.
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Affiliation(s)
- Hanane Delsa
- Department of Gastroenterology and Hepatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Casablanca 82403, Morocco
| | | | - Hussein Hassan Okasha
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Endoscopy, Kasr Al-Ainy School of Medicine, Cairo university, Cairo 11562, Egypt
| | - Fahd Ghalim
- Department of Gastroenterology and Hepatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Casablanca 82403, Morocco
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Okasha HH, Pawlak KM, Abou-elmagd A, El-Meligui A, Atalla H, Othman MO, Elenin SA, Alzamzamy A, Mahdy RE. Practical approach to linear endoscopic ultrasound examination of the rectum and anal canal. Endosc Int Open 2022; 10:E1417-E1426. [PMID: 36262505 PMCID: PMC9576334 DOI: 10.1055/a-1922-6500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/08/2022] [Indexed: 11/09/2022] Open
Abstract
Standard endosonographic examination of the rectal area is usually performed with radial endoscopic ultrasound (EUS). However, in recent years, widespread availability of linear EUS for assessing various anatomical regions in the gastrointestinal tract has facilitated its use in the assessment of anorectal disorders. Currently, many rectal and anal diseases, including perianal abscesses, fistulae, polyps, and neoplastic lesions, can be well-visualized and evaluated with linear EUS. The aim of this review is to shed light on the anatomy and systematic examination of the anorectal region with linear EUS and clinical implications for different anorectal pathologies.
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Affiliation(s)
- Hussein Hassan Okasha
- Internal Medicine Department, Division of Gastroenterology, Kasr Al-Aini School of Medicine, Cairo University, Cairo, Egypt
| | - Katarzyna M. Pawlak
- Hospital of the Ministry of Interior and Administration, Endoscopy Unit, Department of Gastroenterology, Szczecin, Poland
| | | | - Ahmed El-Meligui
- Internal Medicine Department, Division of Gastroenterology, Kasr Al-Aini School of Medicine, Cairo University, Cairo, Egypt
| | - Hassan Atalla
- Internal Medicine Department, Hepatology and Gastroenterology Unit, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Sameh Abou Elenin
- Department of Gastroenterology and Hepatology, Military Medical Academy, Cairo Egypt
| | - Ahmed Alzamzamy
- Department of Gastroenterology and Hepatology, Military Medical Academy, Cairo Egypt
| | - Reem Ezzat Mahdy
- Internal Medicine, gastroenterology and Hepatology Department, Assiut University, Assiut, Egypt
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Eissa M, Okasha HH, Abbasy M, Khamis AK, Abdellatef A, Rady MA. Role of endoscopic ultrasound in evaluation of patients with missed common bile duct stones. World J Gastrointest Endosc 2022; 14:564-574. [PMID: 36186945 PMCID: PMC9516471 DOI: 10.4253/wjge.v14.i9.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/26/2022] [Accepted: 09/06/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Choledocholithiasis develops in up to 20% of patients with gall bladder stones. The challenge in diagnosis usually occurs with small stones that may be missed by magnetic resonance cholangiopancreatography (MRCP). Endoscopic ultrasound (EUS) is accurate in detecting common bile duct (CBD) stones missed by MRCP, especially the small ones or those impacted at the distal CBD or the papillary region.
AIM To evaluate the accuracy of EUS in detecting CBD stones missed by MRCP.
METHODS Patients with an intermediate likelihood of choledocholithiasis according to ESGE guidelines and those with acute pancreatitis of undetermined cause were included. The presence of choledocholithiasis was evaluated by MRCP and EUS, and then results were confirmed by endoscopic retrograde cholangiopancreatography (ERCP). The sensitivity and specificity of EUS and MRCP were compared regarding the presence of stones, the size, and the number of detected stones.
RESULTS Ninety out of 100 involved patients had choledocholithiasis, while ten patients were excluded as they had pancreatic or gall bladder masses during EUS examination. In choledocholithiasis patients, the mean age was 52.37 ± 14.64 years, and 52.2% were males. Most patients had biliary obstruction (74.4%), while only 23 (25.6%) patients had unexplained pancreatitis. The overall prevalence of choledocholithiasis was 83.3% by EUS, 41.1% by MRCP, and 74.4% by ERCP. Also, the number and size of CBD stones could be detected accurately in 78.2% and 75.6% by EUS and 41.1% and 70.3% by MRCP, respectively. The sensitivity of EUS was higher than that of MRCP (98.51% vs 55.22%), and their predictive value was statistically different (P < 0.001). Combination of both tools raised the sensitivity to 97.22% and specificity to 100%.
CONCLUSION EUS could be a useful tool in assessing patients with suspected choledocholithiasis especially if combined with MRCP. However, its usefulness depends on its availability and the experience of the local centers.
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Affiliation(s)
- Mohamed Eissa
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Menoufia 32951, Egypt
| | - Hussein Hassan Okasha
- Department of Internal Medicine, Hepatogastroenterology Division, Kasr AL-Ainy School of Medicine, Cairo University, Cairo 11451, Egypt
| | - Mohamed Abbasy
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Menoufia 32951, Egypt
| | - Ahmed Kamal Khamis
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Menoufia 32951, Egypt
| | - Abeer Abdellatef
- Department of Internal Medicine, Hepatogastroenterology Division, Kasr AL-Ainy School of Medicine, Cairo University, Cairo 11451, Egypt
| | - Mohamed Akl Rady
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Menoufia 32951, Egypt
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11
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Okasha HH, Wahba M, Fontagnier E, Abdellatef A, Haggag H, AbouElenin S. Hidden local recurrence of colorectal adenocarcinoma diagnosed by endoscopic ultrasound: A case series. World J Gastrointest Endosc 2022; 14:502-507. [PMID: 36158634 PMCID: PMC9453309 DOI: 10.4253/wjge.v14.i8.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/29/2022] [Accepted: 07/18/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Almost half of the patients with colorectal cancer (CRC) will experience local-regional recurrence after standard surgical excision. Many local recurrences of colorectal cancer (LRCC) do not grow intraluminally, and some may be covered by a normal mucosa so that they could be missed by colonoscopy. Early detection is crucial as it offers a chance to achieve curative reoperation. Endoscopic ultrasound (EUS) is mainly used in CRC staging combined with cross-section imaging study. EUS can provide an accurate assessment of sub-mucosal lesions by demarcating the originating wall layer and evaluating its echostructure. EUS fine-needle aspiration (FNA) provides the required tissue examination and confirms the diagnosis.
CASE SUMMARY We report a series of five cases referred to surveillance for LRCC with negative colonoscopy and/or negative endoscopic biopsies. EUS-FNA confirmed LRCC implanted deep into the third and fourth wall layer with normal first and second layer.
CONCLUSION Assessment for LCRR is still problematic and may be very tricky. EUS and EUS-FNA may be useful tools to exclude local recurrence.
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Affiliation(s)
- Hussein Hassan Okasha
- Department of Internal Medicine and Hepatogastroenterology, Kasr Al-Aini Hospitals, Cairo University, Cairo 11451, Egypt
| | - Mahmoud Wahba
- Department of Internal Medicine and Hepatogastroenterology, Kasr Al-Aini Hospitals, Cairo University, Cairo 11451, Egypt
| | - Eva Fontagnier
- Department of Internal Medicine and Gastroenterology, Tawam Hospital, Al-Ain 00000, United Arab Emirates
| | - Abeer Abdellatef
- Department of Internal Medicine and Hepatogastroenterology, Kasr Al-Aini Hospitals, Cairo University, Cairo 11451, Egypt
| | - Hani Haggag
- Department of Internal Medicine and Hepatogastroenterology, Kasr Al-Aini Hospitals, Cairo University, Cairo 11451, Egypt
| | - Sameh AbouElenin
- Department of Internal Medicine and Gastroenterology, Military Medical Academy, Cairo 11451, Egypt
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12
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Okasha HH, Abdellatef A, Elkholy S, Mogawer MS, Yosry A, Elserafy M, Medhat E, Khalaf H, Fouad M, Elbaz T, Ramadan A, Behiry ME, Y William K, Habib G, Kaddah M, Abdel-Hamid H, Abou-Elmagd A, Galal A, Abbas WA, Altonbary AY, El-Ansary M, Abdou AE, Haggag H, Abdellah TA, Elfeki MA, Faheem HA, Khattab HM, El-Ansary M, Beshir S, El-Nady M. Role of endoscopic ultrasound and cyst fluid tumor markers in diagnosis of pancreatic cystic lesions. World J Gastrointest Endosc 2022; 14:402-415. [PMID: 35978716 PMCID: PMC9265252 DOI: 10.4253/wjge.v14.i6.402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/28/2021] [Accepted: 05/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreatic cystic lesions (PCLs) are common in clinical practice. The accurate classification and diagnosis of these lesions are crucial to avoid unnecessary treatment of benign lesions and missed opportunities for early treatment of potentially malignant lesions.
AIM To evaluate the role of cyst fluid analysis of different tumor markers such as cancer antigens [e.g., cancer antigen (CA)19-9, CA72-4], carcinoembryonic antigen (CEA), serine protease inhibitor Kazal-type 1 (SPINK1), interleukin 1 beta (IL1-β), vascular endothelial growth factor A (VEGF-A), and prostaglandin E2 (PGE2)], amylase, and mucin stain in diagnosing pancreatic cysts and differentiating malignant from benign lesions.
METHODS This study included 76 patients diagnosed with PCLs using different imaging modalities. All patients underwent endoscopic ultrasound (EUS) and EUS-fine needle aspiration (EUS-FNA) for characterization and sampling of different PCLs.
RESULTS The mean age of studied patients was 47.4 ± 11.4 years, with a slight female predominance (59.2%). Mucin stain showed high statistical significance in predicting malignancy with a sensitivity of 87.1% and specificity of 95.56%. It also showed a positive predictive value and negative predictive value of 93.1% and 91.49%, respectively (P < 0.001). We found that positive mucin stain, cyst fluid glucose, SPINK1, amylase, and CEA levels had high statistical significance (P < 0.0001). In contrast, IL-1β, CA 72-4, VEGF-A, VEGFR2, and PGE2 did not show any statistical significance. Univariate regression analysis for prediction of malignancy in PCLs showed a statistically significant positive correlation with mural nodules, lymph nodes, cyst diameter, mucin stain, and cyst fluid CEA. Meanwhile, logistic multivariable regression analysis proved that mural nodules, mucin stain, and SPINK1 were independent predictors of malignancy in cystic pancreatic lesions.
CONCLUSION EUS examination of cyst morphology with cytopathological analysis and cyst fluid analysis could improve the differentiation between malignant and benign pancreatic cysts. Also, CEA, glucose, and SPINK1 could be used as promising markers to predict malignant pancreatic cysts.
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Affiliation(s)
- Hussein Hassan Okasha
- Department of Internal Medicine and Hepatogastroenterology, Kasr Al-Aini Hospitals, Cairo University, Kasr Al-Aini Hospitals, Cairo University, Cairo 11451, Egypt
| | - Abeer Abdellatef
- Department of Internal Medicine and Hepatogastroenterology, Kasr Al-Aini Hospitals, Cairo University, Kasr Al-Aini Hospitals, Cairo University, Cairo 11451, Egypt
| | - Shaimaa Elkholy
- Department of Internal Medicine and Hepatogastroenterology, Kasr Al-Aini Hospitals, Cairo University, Kasr Al-Aini Hospitals, Cairo University, Cairo 11451, Egypt
| | - Mohamad-Sherif Mogawer
- Department of Internal Medicine and Hepatogastroenterology, Kasr Al-Aini Hospitals, Cairo University, Kasr Al-Aini Hospitals, Cairo University, Cairo 11451, Egypt
| | - Ayman Yosry
- Department of Endemic Diseases, Cairo University, Cairo 11451, Egypt
| | - Magdy Elserafy
- Department of Endemic Diseases, Cairo University, Cairo 11451, Egypt
| | - Eman Medhat
- Department of Endemic Diseases, Cairo University, Cairo 11451, Egypt
| | - Hanaa Khalaf
- Department of Tropical Medicine and Gastroenterology, Minia University, Minia 61511, Egypt
| | - Magdy Fouad
- Department of Tropical Medicine and Gastroenterology, Minia University, Minia 61511, Egypt
| | - Tamer Elbaz
- Department of Endemic Diseases, Cairo University, Cairo 11451, Egypt
| | - Ahmed Ramadan
- Department of Endemic Diseases, Cairo University, Cairo 11451, Egypt
| | - Mervat E Behiry
- Department of Internal Medicine, Kasr Al-Aini Hospitals, Cairo University, Cairo 11562, Egypt
| | - Kerolis Y William
- Department of Internal Medicine and Hepatogastroenterology, Kasr Al-Aini Hospitals, Cairo University, Kasr Al-Aini Hospitals, Cairo University, Cairo 11451, Egypt
| | - Ghada Habib
- Department of Endemic Diseases, Cairo University, Cairo 11451, Egypt
| | - Mona Kaddah
- Department of Endemic Diseases, Cairo University, Cairo 11451, Egypt
| | - Haitham Abdel-Hamid
- Department of Tropical Medicine and Gastroenterology, Minia University, Minia 61511, Egypt
| | - Amr Abou-Elmagd
- Department of Gastroenterology, Armed forces College of Medicine, Cairo 11451, Egypt
| | - Ahmed Galal
- Endoscopy and Internal Medicine Consultant at Dr/Ahmed Galal Endoscopy Center, Alexandria 35516, Egypt
| | - Wael A Abbas
- Department of Internal Medicine, Faculty of Medicine, Assuit University, Assuit 71111, Egypt
| | | | - Mahmoud El-Ansary
- Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo 11451, Egypt
| | - Aml E Abdou
- Department of Microbiology and Immunology, Faculty of Medicine for girls Al-Azhar University, Cairo 11451, Egypt
| | - Hani Haggag
- Department of Internal Medicine and Hepatogastroenterology, Kasr Al-Aini Hospitals, Cairo University, Kasr Al-Aini Hospitals, Cairo University, Cairo 11451, Egypt
| | - Tarek Ali Abdellah
- Department of Internal Medicine, Faculty of Medicine, Ain shams University, Cairo 11451, Egypt
| | - Mohamed A Elfeki
- Department of Internal Medicine, Bani-suef University, Bani-suef, Bani-suef 62511, Egypt
| | - Heba Ahmed Faheem
- Department of Internal Medicine, Faculty of Medicine, Ain shams University, Cairo 11451, Egypt
| | - Hani M Khattab
- Department of Pathology, Faculty of Medicine, Cairo University, Cairo 11451, Egypt
| | - Mervat El-Ansary
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Cairo 11451, Egypt
| | - Safia Beshir
- Department of Environmental Medicine & Clinical Pathology, National Research Centre, Cairo 11451, Egypt
| | - Mohamed El-Nady
- Department of Internal Medicine and Hepatogastroenterology, Kasr Al-Aini Hospitals, Cairo University, Kasr Al-Aini Hospitals, Cairo University, Cairo 11451, Egypt
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Yousri M, Abusinna E, Tahoun N, Okasha HH, El-Habashi AH. A Comparative Study of the Diagnostic Utility of Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology (EUS-FNA) versus Endoscopic Ultrasound-Guided Fine Needle Biopsy (EUS-FNB) in Pancreatic and Non-Pancreatic Lesions. Asian Pac J Cancer Prev 2022; 23:2151-2158. [PMID: 35763660 PMCID: PMC9587825 DOI: 10.31557/apjcp.2022.23.6.2151] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Indexed: 11/25/2022]
Abstract
Objectives: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become the procedure of choice to obtain samples from pancreatic lesions. However, it still has limitations affecting its diagnostic yield. The endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) needle was developed to allow acquisition of histological core. We conducted this study to compare the diagnostic yield of the Echotip 22Gauge FNA needle with the 22Gauge acquire FNB needle in pancreatic and non-pancreatic lesions. Materials and Methods: This prospective study was carried out on 100 cases of pancreatic and non-pancreatic lesions referred to El-Ebrashi unit of Gastroenterology and Hepatology, internal medicine department, Kasr Al-Aini hospital. The patients included were then randomized for sampling using either the standard Echotip 22Gauge FNA needle or 22Gauge acquire FNB needle. Results: Patients were 57 males and 43 females with a mean age of 58±15 years. Seventy-eight patients had pancreatic lesions, while twenty-two patients had non-pancreatic lesions. Half of the patients (50 cases) underwent EUS-FNA, and the other half (50 cases) underwent EUS-FNB. The presence of adequate tissue core was significantly higher in the FNB group. In contrast, smear cellularity was not significantly different between both groups. FNB had more sensitivity and accuracy depending on cell block/tissue core examination only for diagnosing pancreatic lesions. Blood contamination was higher in cell blocks of the FNA group. The sensitivity, specificity, and accuracy in the combined cytologic and histologic evaluation were 100%. Based on smear only or tissue only, the specificity was 100%, but the sensitivity and accuracy were decreased in both techniques. No complications were reported in both techniques. Conclusion: EUS-guided FNA and FNB are safe with comparable diagnostic accuracy in pancreatic and non-pancreatic lesions. FNB improved the histopathological quality of specimens with little blood contamination. Depending on tissue examination only in diagnosing pancreatic lesions, FNB had more sensitivity and diagnostic accuracy.
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Affiliation(s)
- Mohamed Yousri
- Department of Pathology, National Cancer Institute, Cairo University, Egypt
| | - Eman Abusinna
- Department of Pathology, National Cancer Institute, Cairo University, Egypt
| | - Neveen Tahoun
- Department of Pathology, National Cancer Institute, Cairo University, Egypt
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14
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Okasha HH, Aboubakr A, Elenin SA, Atalla H, Alzamzamy A. Unexpected adverse events of endoscopic polypectomy of a juxtapapillay duodenal gastrinoma. Gastrointest Endosc 2022; 95:589-590. [PMID: 34800490 DOI: 10.1016/j.gie.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/11/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Hussein Hassan Okasha
- Department of Internal Medicine and Gastroenterology, Hepatology Unit, Kasr Al-Aini Hospitals, Cairo University, Cairo, Egypt
| | - Ashraf Aboubakr
- Department of Gastroenterology and Hepatology, Maadi Armed Forces Medical Complex, Military Medical Academy, Cairo, Egypt
| | - Sameh Abou Elenin
- Department of Gastroenterology and Hepatology, Maadi Armed Forces Medical Complex, Military Medical Academy, Cairo, Egypt
| | - Hassan Atalla
- Internal Medicine Department, Hepatology and Gastroenterology Unit, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Alzamzamy
- Department of Gastroenterology and Hepatology, Maadi Armed Forces Medical Complex, Military Medical Academy, Cairo, Egypt
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15
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Kaddah M, Okasha HH, Hasan EM, Elbaz T, El Ansary M, Khattab H, Yosry A. The Role of Interleukin 1 Beta in Differentiating Malignant from Benign Pancreatic Cysts. J Interferon Cytokine Res 2022; 42:118-126. [PMID: 35298289 DOI: 10.1089/jir.2021.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background and Aim: The frequency of detection of pancreatic cystic lesions (PCLs) in magnetic resonance imaging performed for reasons unrelated to the pancreas reaches up to 13.5%. The aim of this study was to evaluate the role of cyst fluid interleukin 1 beta (IL1β) and different endoscopic ultrasound (EUS) features in differentiating premalignant/malignant from benign pancreatic cysts. In addition, to evaluate the role of pancreatic cyst fluid carcinoembryonic antigen (CEA) in differentiating mucinous from nonmucinous pancreatic cysts. Methods: This study was conducted on 73 patients with PCLs. EUS-guided fine-needle aspiration (EUS-FNA) was performed on all patients. Estimation of IL1β and CEA levels in aspirated specimens were carried out. Results: Pancreatic cyst fluid IL1β level could not differentiate between premalignant/malignant and benign pancreatic cysts. At a cutoff value of 19.81 ng/mL pancreatic cyst fluid CEA has 64.3% sensitivity and 84.4% specificity in differentiating mucinous from nonmucinous pancreatic cyst. EUS can differentiate between premalignant/malignant pancreatic cysts and benign cysts with a sensitivity of 66.7%, specificity of 69.2% Conclusions: Pancreatic cyst fluid IL1β level cannot differentiate between premalignant/malignant and benign pancreatic cysts. CEA level can help in differentiation between mucinous and nonmucinous cysts. EUS can be useful in differentiation between premalignant/malignant pancreatic cysts and benign cysts.
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Affiliation(s)
- Mona Kaddah
- Department of Endemic Diseases, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hussein Hassan Okasha
- Department of Internal Medicine and Gastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman Medhat Hasan
- Department of Endemic Diseases, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Tamer Elbaz
- Department of Endemic Diseases, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mervat El Ansary
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hany Khattab
- Department of Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman Yosry
- Department of Endemic Diseases, Faculty of Medicine, Cairo University, Cairo, Egypt
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16
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Ragab KM, El-Kassas M, Madkour A, Okasha HH, Agwa RH, Ghoneem EA. Safety and efficacy of endoscopic ultrasound as a diagnostic and therapeutic tool in pediatric patients: a multicenter study. Ther Adv Gastrointest Endosc 2022; 15:26317745221136767. [PMID: 36407679 PMCID: PMC9669673 DOI: 10.1177/26317745221136767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 10/17/2022] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Despite the well-established diagnostic and therapeutic applications of endoscopic ultrasound (EUS) in adults, data about its use in children are limited. In this study, we tried to assess the feasibility, safety, and clinical impact of EUS in pediatric patients. METHODS Data of pediatric patients (<18 years) referred for EUS over a 3-year period to the endoscopy units of four Egyptian tertiary centers were retrospectively analyzed. Significant impact was defined as a new diagnosis or treatment attributed to the EUS procedure. RESULTS Twenty-four diagnostic and five therapeutic EUS procedures were conducted in 29 children with a median age of 9 years. Indications for EUS included assessment of solid pancreatic mass (n = 3), pancreatic cyst (n = 2), suspected chronic pancreatitis (n = 9), pancreatic pseudocyst (PPC) (n = 5), recurrent hypoglycemia (n = 1), bile duct mass (n = 1), subepithelial lesion (esophageal, duodenal or anorectal) (n = 4), mediastinal mass (n = 1), pelvic mass (n = 3), and mass at splenic hilum (n = 1). Therapeutically, five patients underwent cystogastrostomy for symptomatic PPC with 100% technical and clinical success. EUS was able to diagnose 21 out of the other 24 patients. EUS-guided tissue acquisition was performed in 11 patients with definitive histopathological diagnosis in 10 patients (91%). There was no procedure-related major complication, while minor complications occurred in two cases (transient pain in one case, temporary fever, and vomiting in two cases). CONCLUSION Standard linear EUS equipment and accessories can be used safely and effectively in selected pediatric patients for diagnostic and therapeutic purposes.
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Affiliation(s)
- Khalid Mohamed Ragab
- Hepatology and Gastroenterology Department,
Theodor Bilharz Research Institute, Cairo, Egypt
| | - Mohamed El-Kassas
- Endemic Medicine Department, Faculty of
Medicine, Helwan University, Ain Helwan, Cairo 11795, Egypt
| | - Ahmad Madkour
- Endemic Medicine Department, Faculty of
Medicine, Helwan University, Cairo, Egypt
| | | | - Ramy Hassan Agwa
- Hepatology and Gastroenterology Department,
Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Elsayed Awad Ghoneem
- Hepatology and Gastroenterology Department,
Faculty of Medicine, Mansoura University, Mansoura, Egypt
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17
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Okasha HH, El-Meligui A, Pawlak KM, Żorniak M, Atalla H, Abou-Elmagd A, Abou-Elenen S, El-Husseiny R, Alzamzamy A. Practical approach to linear EUS examination of the mediastinum. Endosc Ultrasound 2021; 10:406-413. [PMID: 34854401 PMCID: PMC8785678 DOI: 10.4103/eus-d-21-00019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
EUS has become a substantial diagnostic and therapeutic modality for many anatomical regions. The extent of endosonographic assessment is wide, and among others, allows for the evaluation of the mediastinal anatomy and related pathologies such as mediastinal lymphadenopathy and staging of central malignant lung lesions. Moreover, EUS assessment has proved more accurate in detecting small lesions missed by standard imaging examinations such as computed tomography or magnetic resonance. Endosonographically, various mediastinal anatomical landmarks and stations can be visualized by transesophageal scanning, thus providing arranged systematic examination of the mediastinum. In addition, the correct position during the examination is crucial for EUS-guided procedures such as tissue sampling and drainage of mediastinal abscesses. The evolution of EUS-guided diagnostic and interventional procedures has contributed to the increasing importance of understanding the mediastinal anatomy during the EUS examination.
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Affiliation(s)
- Hussein Hassan Okasha
- Department of Internal Medicine, Division of Gastroenterology, Kasr Al-Aini School of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed El-Meligui
- Department of Internal Medicine, Division of Gastroenterology, Kasr Al-Aini School of Medicine, Cairo University, Cairo, Egypt
| | - Katarzyna M Pawlak
- Department of Internal Medicine, Cardiology, Gastroenterology and Endocrinology, Hospital of the Ministry of Interior and Administration, Szczecin, Poland
| | - Michał Żorniak
- Department of Medicine II, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany; Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
| | - Hassan Atalla
- Department of Internal Medicine, Hepatology and Gastroenterology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Amr Abou-Elmagd
- Department of Internal Medicine, Armed Forces College of Medicine, Cairo, Egypt
| | - Sameh Abou-Elenen
- Department of Gastroenterology and Hepatology, Military Medical Academy, Cairo, Egypt
| | - Ramy El-Husseiny
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Ahmed Alzamzamy
- Department of Gastroenterology and Hepatology, Military Medical Academy, Cairo, Egypt
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18
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Okasha HH, Wifi MN, Awad A, Abdelfatah Y, Abdelfatah D, El-Sawy SS, Alzamzamy A, Abou-Elenin S, Abou-Elmagd A, ElHusseiny R, Wahba M, El-Feki MA, Pawlak KM. Role of EUS in detection of liver metastasis not seen by computed tomography or magnetic resonance imaging during staging of pancreatic, gastrointestinal, and thoracic malignancies. Endosc Ultrasound 2021; 10:344-354. [PMID: 34558421 PMCID: PMC8544012 DOI: 10.4103/eus-d-20-00178] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background and Objectives: Liver metastases might not be detected by computed tomography (CT) and magnetic resonance imaging (MRI) due to their small size, but they can be detected by EUS. Furthermore, EUS-FNA has a significant impact on improving the diagnostic accuracy of EUS. The purpose of this study was to assess the feasibility of EUS in detection of occult small hepatic focal lesions at the time of primary tumor staging, not seen by CT or MRI. Methods: This prospective study included 730 patients who underwent EUS for staging or sampling of gastrointestinal, pancreatic, or thoracic malignancy. The liver was examined thoroughly for detection of occult lesions. CT or MRI was done within 1 week of EUS examination. Results: EUS examination of the liver detected focal lesions in 150 patients (20.5%) and metastases in 118 patients (16.2%); meanwhile, CT and MRI detected focal lesions in 99 patients (13.6%) and metastases in 82 patients (11.2%). EUS missed focal lesions in 7 patients, 6 of which were liver metastases (1.0% and 0.8%, respectively), while CT and MRI missed focal lesions in 58 patients, 42 of which were metastases (7.9% and 5.8%, respectively), which were detected by EUS. Conclusion: Thorough dedicated EUS examination of the liver is a feasible useful tool for detection of small hepatic lesions missed by CT and MRI. It is not considered an extra financial burden to the patient or health-care system because those patients are indicated for EUS examination for evaluation of their original lesion in the first place. Furthermore, EUS-FNA can add another advantage in diagnosing the etiology of such lesions.
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Affiliation(s)
- Hussein Hassan Okasha
- Department of Internal Medicine, Hepatogastroenterology Unit, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed-Naguib Wifi
- Department of Internal Medicine, Hepatogastroenterology Unit, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Abeer Awad
- Department of Internal Medicine, Hepatogastroenterology Unit, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Yasmine Abdelfatah
- Department of Internal Medicine, Endocrinology and Metabolism Unit, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Abdelfatah
- Department of Cancer Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Shereen Sadik El-Sawy
- Department of Internal Medicine, Endocrinology and Metabolism Unit, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Alzamzamy
- Department of Gastroenterology and Hepatology, Maadi Armed Forces Medical Complex, Military Medical Academy, Cairo, Egypt
| | - Sameh Abou-Elenin
- Department of Gastroenterology and Hepatology, Military Medical Academy, Cairo, Egypt
| | - Amr Abou-Elmagd
- Department of Gastroenterology and Hepatology, Armed Forces College of Medicine, Cairo, Egypt
| | - Ramy ElHusseiny
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Mahmoud Wahba
- Department of Internal Medicine, Hepatogastroenterology Unit, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed A El-Feki
- Department of Internal Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Katarzyna M Pawlak
- Department of Internal Medicine, Cardiology, Gastroenterology and Endocrinology, Hospital of the Ministry of Interior and Administration, Szczecin, Poland
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19
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Ragab K, Elmeligui AM, Atalla H, Okasha HH. An unexpected complication during EUS-FNA. Endosc Ultrasound 2021; 11:145-146. [PMID: 34494583 PMCID: PMC9059800 DOI: 10.4103/eus-d-21-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Khaled Ragab
- Division of Gastroenterology, Hepatology and Endoscopy, Theodor Bilharz Research Institute, Giza, Egypt
| | - Ahmed Mohammed Elmeligui
- Division of Gastroenterology, Hepatology and Endoscopy, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Hassan Atalla
- Department of Internal Medicine, Hepatology and Gastroenterology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hussein Hassan Okasha
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Endoscopy, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
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Deshmukh A, Elmeligui AM, Okasha HH, Parsa N, Tejedor-Tejada J, Nieto J. EUS-guided fiducial gold marker placement in metastatic colon cancer to the spleen. Endosc Ultrasound 2021; 11:79-80. [PMID: 34213433 PMCID: PMC8887036 DOI: 10.4103/eus-d-21-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Ahmed Mohammed Elmeligui
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Endoscopy, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Hussein Hassan Okasha
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Endoscopy, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Nasim Parsa
- Division of Gastroenterology, Hepatology and Endoscopy, University of Missouri School of Medicine, Columbia, MO, USA
| | - Javier Tejedor-Tejada
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Jose Nieto
- Division of Gastroenterology, Hepatology and Endoscopy, Borland Groover Clinic, Jacksonville, FL, USA
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Okasha HH, Awad A, El-meligui A, Ezzat R, Aboubakr A, AbouElenin S, El-Husseiny R, Alzamzamy A. Cystic pancreatic lesions, the endless dilemma. World J Gastroenterol 2021; 27:2664-2680. [PMID: 34135548 PMCID: PMC8173383 DOI: 10.3748/wjg.v27.i21.2664] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/14/2021] [Accepted: 05/10/2021] [Indexed: 02/06/2023] Open
Abstract
Cystic pancreatic lesions involve a wide variety of pathological entities that include neoplastic and non-neoplastic lesions. The proper diagnosis, differentiation, and staging of these cystic lesions are considered a crucial issue in planning further management. There are great challenges for their diagnostic models. In our time, new emerging methods for this diagnosis have been discovered. Endoscopic ultrasonography-guided fine-needle aspiration cytology with chemical and molecular analysis of cyst fluid and EUS-guided fine needle-based confocal laser endomicroscopy, through the needle microforceps biopsy, and single-operator cholangioscopy/pancreatoscopy are promising methods that have been used in the diagnosis of cystic pancreatic lesions. Hereby we discuss the diagnosis of cystic pancreatic lesions and the benefits of various diagnostic models.
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Affiliation(s)
- Hussein Hassan Okasha
- Department of Internal Medicine and Gastroenterology, Hepatology Unit, Kasr Al-Aini Hospitals, Cairo University, Cairo 11562, Egypt
| | - Abeer Awad
- Department of Internal Medicine and Gastroenterology, Hepatology Unit, Kasr Al-Aini Hospitals, Cairo University, Cairo 11562, Egypt
| | - Ahmed El-meligui
- Department of Internal Medicine and Gastroenterology, Hepatology Unit, Kasr Al-Aini Hospitals, Cairo University, Cairo 11562, Egypt
| | - Reem Ezzat
- Department of Internal Medicine and Gastroenterology, Hepatology Unit, Assuit University, Assuit 71515, Egypt
| | - Ashraf Aboubakr
- Department of Gastroenterology and Hepatology, Maadi Armed Forces Medical Complex, Military Medical Academy, Cairo 11441, Egypt
| | - Sameh AbouElenin
- Department of Gastroenterology and Hepatology, Military Medical Academy, Cairo 11441, Egypt
| | - Ramy El-Husseiny
- Department of Hepatology and Tropical Medicine, National Hepatology and Tropical Medicine Research Institute (NHTMRI), Cairo 11441, Egypt
| | - Ahmed Alzamzamy
- Department of Gastroenterology and Hepatology, Maadi Armed Forces Medical Complex, Military Medical Academy, Cairo 11441, Egypt
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Hassan Okasha H, El-Amin H, El-Abdeen Sayed Z, Maghraby AAE. Role of Endoscopic Ultrasound Elastography Strain Histograms in the Evaluation of Patients with Pancreatic Masses. Turk J Gastroenterol 2021; 32:519-525. [PMID: 34405818 PMCID: PMC8975467 DOI: 10.5152/tjg.2021.20678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/04/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The Endoscopic Ultrasound (EUS) quantitative elastography strain ratio (SR) and strain histogram (SH) methods for noninvasive pancreatic masses differentiation have been recently developed. The aim of this research was to investigate the accuracy of the diagnostic differentiation methods for patients with pancreatic masses, based on the EUS SR and SH. METHODS This is a prospective study involving 100 cases with pancreatic masses. Patients were classified into 2 groups: group that was diagnosed with pancreatic malignancy with positive histopathology by biopsy obtained by fine-needle aspiration or postoperative pathology (72 patients) and the group diagnosed with pancreatitis with negative pathology and follow-up for at least 1 year (28 patients). RESULTS Based on the ROC curve, the cut-off point for Mode 1 was set at 97. Values under it showed the presence of malignant pancreatic masses. Mode 1 achieved a sensitivity of 89% and a specificity of 43% with an overall accuracy of 76%. The predictive positive value was 70%, and the predictive negative value was 60%. The cut-off point for SR was set at 3.04, and the values were equal or above the suggested pancreatic malignancy. The SR achieved a sensitivity of 95.83%, a specificity of 61%, with an overall accuracy of 86%. The predictive positive and negative values were 86.2% and 85%, respectively. CONCLUSION Mode 1 SH showed good sensitivity in the identification of pancreatic malignant tumors but were disappointingly of low specificity. Higher sensitivity, specificity, and overall accuracy were obtained by using the SR.
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Affiliation(s)
- Hussein Hassan Okasha
- Hepatogastroenterology Unit, Department of Internal Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Hussein El-Amin
- Hepatogastroenterology Unit, Department of Internal Medicine, Assiut University Hospital, Egypt
| | - Zain El-Abdeen Sayed
- Hepatogastroenterology Unit, Department of Internal Medicine, Assiut University Hospital, Egypt
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Okasha HH, Mansor M, Sheriba N, Assem M, Abdelfattah Y, Ashoush OA, Rakha M, Abdelfattah D, El-Sawy SS, Elshenoufy M, Mohsen AA, Sedrak HK, Abdellatif AA. Role of elastography strain ratio and TIRADS score in predicting malignant thyroid nodule. Arch Endocrinol Metab 2021; 64:735-742. [PMID: 34033283 PMCID: PMC10528627 DOI: 10.20945/2359-3997000000283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/12/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Ultrasonography (US) is the most accurate and cost-effective imaging method in diagnosis of thyroid nodules. A practical thyroid imaging reporting and data system (TIRADS) for thyroid nodules has been proposed to classify nodules of the thyroid gland to solve the problem of nodule selection for fine needle aspiration cytology (FNAC). Real-time elastography and strain ratio (SR) is a method used to assess the stiffness and predict the malignancy of thyroid nodules. The objective of this study was to assess the role of elastography and SR and the TIRADS scoring system in discriminating malignant from benign thyroid nodules. METHODS From 2015 to 2018 at Cairo University Hospital, a series of 409 patients with thyroid nodules was referred to undergo thyroid ultrasound. Categorization of each nodule according to the TIRADS ranged from 1 to 5. The qualitative elastography score and semiquantitative SR of the nodules were evaluated. Final diagnosis was done by either post-thyroidectomy histopathological examination or US-guided FNAC. RESULTS Our study included 409 patients with thyroid nodules. Their mean age was 39 ± 10 SD; 36 were males and 373 were females. There were 22 malignant nodules and 387 benign nodules. There were statistical differences between benign and malignant nodules regarding TIRADS classification, SR, anteroposterior/transverse ratio, degree of echogenicity, border, presence of calcification, and absence of halo sign (P < 0.001). The elastic properties of thyroid nodules proved to be a good discriminator between malignant and benign nodules (P- < 0.001) at a cut off value of > 2.32 with 95.2% sensitivity and 86.5% specificity. For every unit increase in SR, the risk of malignancy increased by nearly 2 times. Patients with irregular borders had nearly 17 times increased risk of malignancy than those with regular borders. CONCLUSION Elastography and SR proved to be of high significant value in discriminating benign from malignant nodules, so we recommend adding it to the TIRADS classification.
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Affiliation(s)
| | - Mona Mansor
- Kasr Al-Aini Hospitals, Cairo University, Cairo, Egypt
| | | | - Maha Assem
- Kasr Al-Aini Hospitals, Cairo University, Cairo, Egypt
| | | | - Omar A Ashoush
- Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maha Rakha
- Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dalia Abdelfattah
- Biostatistic and Cancer Epidemiology Department, National Cancer Institute, Cairo University, Cairo, Egypt
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Affiliation(s)
- Ahmed Mohamed Elmeligui
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Endoscopy, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Ameya Deshmukh
- Department of Internal Medicine, Midwestern University - CCOM, Downers Grove, IL, USA
| | - Hussein Hassan Okasha
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Endoscopy, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Nasim Parsa
- Division of Gastroenterology, Hepatology and Endoscopy, University of Missouri School of Medicine, Columbia MO, USA
| | - Javier Tejedor-Tejada
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Jose Nieto
- Division of Gastroenterology, Hepatology and Endoscopy, Borland Groover Clinic, Jacksonville, FL, USA
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Abstract
EUS has become a substantial diagnostic and therapeutic modality for digestive tract conditions. The extent of endosonographic assessment is wide, and, among others, it allows for the evaluation of liver anatomy and related pathologies. Moreover, EUS assessment has proved more accurate in detecting small focal liver lesions missed by standard imaging examinations such as computed tomography or magnetic resonance. Endosonographically, various liver segments can be visualized by transgastric and transduodenal scanning following anatomical landmarks, thus providing arranged systematic examination. In addition, knowledge considering the correct position during examination is crucial for EUS-guided procedures such as hepaticogastrostomy, ablation of tumors, and measurement of portal pressure gradient. The evolution of EUS-guided intervention has contributed to the increasing importance of understanding the hepatic segmental anatomy during the EUS examination.
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Affiliation(s)
- Hussein Hassan Okasha
- Department of Internal Medicine, Division of Gastroenterology, Kasr Al-Aini School of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud Farouk
- Department of Tropical Medicine and Gastroenterology, Assiut University, Assiut, Egypt
| | | | - Rasha Mohamed Mahmoud
- Department of Internal Medicine, Gastroenterology Unit, Assiut University, Assiut, Egypt
| | - Ahmed El-Meligui
- Department of Internal Medicine, Division of Gastroenterology, Kasr Al-Aini School of Medicine, Cairo University, Cairo, Egypt
| | - Hassan Atalla
- Department of Internal Medicine, Hepatology and Gastroenterology Unit, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Morad Hashim
- Department of Internal Medicine, Division of Gastroenterology, Kasr Al-Aini School of Medicine, Cairo University, Cairo, Egypt
| | - Katarzyna M Pawlak
- Department of Internal Medicine, Cardiology, Gastroenterology and Endocrinology, Hospital of the Ministry of Interior and Administration, Szczecin, Poland
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Okasha HH, Pawlak KM, Żorniak M, Wiechowska-Kozłowska A, Naga YM, ElHusseiny R. EUS in the evaluation of metastatic lesions to the pancreas. Endosc Ultrasound 2020; 9:147-150. [PMID: 32584308 PMCID: PMC7430902 DOI: 10.4103/eus.eus_31_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Hussein Hassan Okasha
- Department of Internal Medicine, Gastroenterology Division, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Katarzyna M Pawlak
- Department of Internal Medicine, Cardiology, Gastroenterology and Endocrinology, Hospital of the Ministry of Interior and Administration, Szczecin, Poland
| | - Michał Żorniak
- Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland
| | - Anna Wiechowska-Kozłowska
- Department of Internal Medicine, Cardiology, Gastroenterology and Endocrinology, Hospital of the Ministry of Interior and Administration, Szczecin, Poland
| | - Yehia Mazen Naga
- Department of Medicine, Division of Digestive Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ramy ElHusseiny
- Department of Internal Medicine, National Hepatology and Tropical Medicine Research Institute (NHTMRI), Cairo, Egypt
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Affiliation(s)
- Hussein Hassan Okasha
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yehia M Naga
- Department of Medicine, Division of Digestive Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mohammad El Sherbiny
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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Kaheil SHM, El-Baz WF, Abd El Rahman EAR, Mansour HH, Abd El Fattah AS, Okasha HH. Role of Endoscopic Ultrasound-Fine Needle Aspiration in Management of Submucosal Lesions (SMLs) of GIT and Significant Predictors of Malignancy of GIST Lesions. The Egyptian Journal of Hospital Medicine 2020; 78:149-156. [DOI: 10.21608/ejhm.2020.68582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Ge N, Brugge WR, Saxena P, Sahai A, Adler DG, Giovannini M, Pausawasdi N, Santo E, Mishra G, Tam W, Kida M, de la Mora-Levy JG, Sharma M, Umar M, Katanuma A, Lee L, Garg PK, Eloubeidi MA, Yu HK, Raijman I, Arturo Arias BL, Bhutani M, Carrara S, Rai P, Mukai S, Palazzo L, Dietrich CF, Nguyen NQ, El-Nady M, Poley JW, Guaraldi S, Kalaitzakis E, Sabbagh LC, Lariño-Noia J, Gress FG, Lee YT, Rana SS, Fusaroli P, Hocke M, Dhir V, Lakhtakia S, Ratanachu-Ek T, Chalapathi Rao AS, Vilmann P, Okasha HH, Irisawa A, Ponnudurai R, Leong AT, Artifon E, Iglesias-Garcia J, Saftoiu A, Larghi A, Robles-Medranda C, Sun S. An international, multi-institution survey of the use of EUS in the diagnosis of pancreatic cystic lesions. Endosc Ultrasound 2019; 8:418-427. [PMID: 31552915 PMCID: PMC6927137 DOI: 10.4103/eus.eus_61_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background and Objectives: Currently, pancreatic cystic lesions (PCLs) are recognized with increasing frequency and have become a more common finding in clinical practice. EUS is challenging in the diagnosis of PCLs and evidence-based decisions are lacking in its application. This study aimed to develop strong recommendations for the use of EUS in the diagnosis of PCLs, based on the experience of experts in the field. Methods: A survey regarding the practice of EUS in the evaluation of PCLs was drafted by the committee member of the International Society of EUS Task Force (ISEUS-TF). It was disseminated to experts of EUS who were also members of the ISEUS-TF. In some cases, percentage agreement with some statements was calculated; in others, the options with the greatest numbers of responses were summarized. Results: Fifteen questions were extracted and disseminated among 60 experts for the survey. Fifty-three experts completed the survey within the specified time frame. The average volume of EUS cases at the experts' institutions is 988.5 cases per year. Conclusion: Despite the limitations of EUS alone in the morphologic diagnosis of PCLs, the results of the survey indicate that EUS-guided fine-needle aspiration is widely expected to become a more valuable method.
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Affiliation(s)
- Nan Ge
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - William R Brugge
- Department of Gastroenterology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Payal Saxena
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Anand Sahai
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Douglas G Adler
- Division of Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Marc Giovannini
- Endoscopic Unit, Institut Paoli-Calmettes, Marseille, France
| | | | - Erwin Santo
- Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Girish Mishra
- Department of Gastroenterology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - William Tam
- Lyell McEwin Hospital, Elizabeth Vale, Adelaide, Australia
| | - Mitsuhiro Kida
- Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan
| | | | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | | | - Akio Katanuma
- Center for Gastroenterology, Teine-Kenjinkai Hospital, Sapporo, Japan
| | - Linda Lee
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Ho Khek Yu
- National University of Singapore, Singapore
| | - Isaac Raijman
- Digestive Associates of Houston, University of Texas, Houston, Texas, USA
| | | | - Manoop Bhutani
- Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Silvia Carrara
- Digestive Endoscopy Unit, Humanitas Research Hospital, Milan, Italy
| | - Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | | | - Christoph F Dietrich
- Medical Department, Caritas-Krankenhaus, Uhlandstr 7, D-97980 Bad Mergentheim, Germany
| | - Nam Q Nguyen
- Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, Australia
| | - Mohamed El-Nady
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Jan Werner Poley
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Simone Guaraldi
- Participants of the Nucleus of Endoscopy of the Brazilian Society of Digestive Endoscopy (SOBED), São Paulo, Brazil
| | - Evangelos Kalaitzakis
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Jose Lariño-Noia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Yuk-Tong Lee
- Departments of Medicine & Therapeutics and Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Surinder S Rana
- Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna, Bologna, Italy
| | - Michael Hocke
- Department of Medical, Hospital Meiningen, Thuringia, Germany
| | - Vinay Dhir
- Department of Gastroenterology and Endoscopy, S L Raheja Hospital, Mumbai, Maharashtra, India
| | | | | | | | - Peter Vilmann
- GastroUnit, Department of Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hussein Hassan Okasha
- Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt
| | - Atsushi Irisawa
- Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | | | - Ang Tiing Leong
- Departments of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Everson Artifon
- Department of Surgery, Ana Costa Hospital, Sao Paulo, Brazil
| | - Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
| | - Alberto Larghi
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Carlos Robles-Medranda
- Head of the Endoscopy Division, Ecuadorian Institute of Digestive Disease, Guayaquil, Ecuador
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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Okasha HH, Mahdy RE, Elkholy S, Hassan MS, El-Mazny AN, Hadad KEE, Saeed M, El-Nady M, Elbalky OS, Ashraf A, El-Magd AA, Awad A. Endoscopic ultrasound (EUS) elastography and strain ratio, could it help in differentiating malignant from benign pancreatic lesions? Medicine (Baltimore) 2018; 97:e11689. [PMID: 30200064 PMCID: PMC6133468 DOI: 10.1097/md.0000000000011689] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Evaluating the role of endoscopic ultrasound (EUS) elastography and strain ratio in differentiation between malignant and benign pancreatic lesions.Three hundred twenty-five patients with solid pancreatic lesions were enrolled in this prospective study from 2014 to 2017. EUS real-time elastography scoring and strain ratio were done to all patients and compared to the final diagnosis to assess its sensitivity, specificity, positive and negative predictive values (PPV and NPV) in differentiating malignant from benign lesions.A cut-off value of 4.2 we had sensitivity of 95%, specificity of 63%, PPV of 89%, NPV of 81%, and accuracy of 87%. Another cut-off value of 10.9 showed a sensitivity of 75%, specificity of 88%, PPV of 95%, NPV of 54%, and accuracy of 79%. Adding the elastography to the better cut-off value gave a sensitivity of 97%, specificity of 63%, PPV of 89%, NPV of 88%, and accuracy of 89%.Real-time elastography and strain ration are valuable in differentiating malignant from pancreatic lesions.
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Affiliation(s)
| | - Reem Ezzat Mahdy
- Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut
| | - Shaimaa Elkholy
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo
| | | | | | | | - Moustafa Saeed
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo
| | - Mohamed El-Nady
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo
| | | | - Asem Ashraf
- Gastroenterology Department, Military Medical Academy, Egypt
| | - Amr Abo El-Magd
- Internal Medicine Department, Armed forces college of medicine, Cairo
| | - Abeer Awad
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo
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Guo J, Giovannini M, Sahai AV, Saftoiu A, Dietrich CF, Santo E, Fusaroli P, Siddiqui AA, Bhutani MS, Bun Teoh AY, Irisawa A, Arturo Arias BL, Achanta CR, Jenssen C, Seo DW, Adler DG, Kalaitzakis E, Artifon E, Itokawa F, Poley JW, Mishra G, Ho KY, Wang HP, Okasha HH, Lachter J, Vila JJ, Iglesias-Garcia J, Yamao K, Yasuda K, Kubota K, Palazzo L, Sabbagh LC, Sharma M, Kida M, El-Nady M, Nguyen NQ, Vilmann P, Garg PK, Rai P, Mukai S, Carrara S, Parupudi S, Sridhar S, Lakhtakia S, Rana SS, Ogura T, Baron TH, Dhir V, Sun S. A multi-institution consensus on how to perform EUS-guided biliary drainage for malignant biliary obstruction. Endosc Ultrasound 2018; 7:356-365. [PMID: 30531022 PMCID: PMC6289007 DOI: 10.4103/eus.eus_53_18] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background and Objectives: EUS-guided biliary drainage (EUS-BD) was shown to be useful for malignant biliary obstruction (MBO). However, there is lack of consensus on how EUS-BD should be performed. Methods: This was a worldwide multi-institutional survey among members of the International Society of EUS conducted in February 2018. The survey consisted of 10 questions related to the practice of EUS-BD. Results: Forty-six endoscopists of them completed the survey. The majority of endoscopists felt that EUS-BD could replace percutaneous transhepatic biliary drainage after failure of ERCP. Among all EUS-BD methods, the rendezvous stenting technique should be the First choice. Self-expandable metal stents (SEMSs) were recommended by most endoscopists. For EUS-guided hepaticogastrostomy (HGS), superiority of partially-covered SEMS over fully-covered SEMS was not in agreement. 6-Fr cystotomes were recommended for fistula creation. During the HGS approach, longer SEMS (8 or 10 cm) was recommended. During the choledochoduodenostomy approach, 6-cm SEMS was recommended. During the intrahepatic (IH) approach, the IH segment 3 was recommended. Conclusion: This is the first worldwide survey on the practice of EUS-BD for MBO. There were wide variations in practice, and randomized studies are urgently needed to establish the best approach for the management of this condition.
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Affiliation(s)
- Jintao Guo
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Marc Giovannini
- Pathology Unit (Flora Poizat), Institute Paoli-Calmettes, Marseille, France
| | - Anand V Sahai
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Adrian Saftoiu
- Department of Endoscopy, University of Medicine and Pharmacy, Craiova, Romania
| | | | - Erwin Santo
- Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Manoop S Bhutani
- Department of Gastroenterology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony Yuen Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Mibu, Japan
| | | | | | | | - Dong-Wan Seo
- Department of Internal Medicine, Division of Gastroenterology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Douglas G Adler
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Evangelos Kalaitzakis
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Everson Artifon
- Department of Surgery, University of Sao Paulo, Sao Paulo, Brazil
| | - Fumihide Itokawa
- Department of Gastroenterology and Hepatology, Tokyo Adventist Hospital, Tokyo, Japan
| | - Jan Werner Poley
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Girish Mishra
- Department of Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Khek Yu Ho
- Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, China
| | | | | | - Juan J Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Julio Iglesias-Garcia
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Spain
| | | | - Kenjiro Yasuda
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Kensuke Kubota
- Department of Endoscopy, Yokohama City University School of Medicine, Yokohama, Japan
| | | | | | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Specialty Hospital, Meerut, Uttar Pradesh, India
| | - Mitsuhiro Kida
- Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan
| | - Mohamed El-Nady
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nam Q Nguyen
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | - Peter Vilmann
- Division of Endoscopy, Gastro Unit, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | | | - Subbaramiah Sridhar
- Section of Gastroenterology/Hepatology, Augusta University, Augusta, GA, USA
| | - Sundeep Lakhtakia
- Asian Institute of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Takeshi Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Todd H Baron
- Division of Gastroenterology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vinay Dhir
- Department of Gastroenterology, SL Raheja Hospital, Mumbai, Maharashtra, India
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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Okasha HH, Elkholy S, Sayed M, Mahdy RE, ElSherif Y, El Gemeie E, El Magd AA. Endoscopic ultrasound and endoscopic ultrasound-guided fine needle aspiration in the diagnosis of diffuse gastrointestinal lesions with inconclusive endoscopic biopsies. Turk J Gastroenterol 2017; 28:370-376. [DOI: 10.5152/tjg.2017.17071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
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Okasha HH, Galal A, Baddour N. Gastric Kaposi's sarcoma simulating gastric lymphoma during endoscopic ultrasound examination. Endosc Ultrasound 2017; 6:347-349. [PMID: 28685740 PMCID: PMC5664858 DOI: 10.4103/eus.eus_10_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Ahmed Galal
- Department of Internal Medicine, Alexandria Gastroenterology, Hepatology, and Fever Hospital, Endoscopy Unit, Alexandria, Egypt
| | - Nahed Baddour
- Department of Pathology, Alexandria University, Alexandria, Egypt
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Okasha HH, Naguib M, El Nady M, Ezzat R, Al-Gemeie E, Al-Nabawy W, Aref W, Abdel-Moaty A, Essam K, Hamdy A. Role of endoscopic ultrasound and endoscopic-ultrasound-guided fine-needle aspiration in endoscopic biopsy negative gastrointestinal lesions. Endosc Ultrasound 2017. [PMID: 28621291 PMCID: PMC5488517 DOI: 10.4103/2303-9027.201086] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Many cases of gastrointestinal (GI) tumors as lymphoma, adenocarcinoma, and most of submucosal tumors (SMT) such as gastrointestinal stromal tumor (GIST) and leiomyoma are difficult to diagnose as they frequently yield negative endoscopic biopsies. We evaluated the accuracy of endoscopic ultrasound (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) in the diagnosis of endoscopic biopsy negative GI tumors. PATIENTS AND METHODS One hundred and nine patients with biopsy negative GI tumors were included in this prospective study. EUS and EUS-FNA were performed to all patients with cytopathologic examination. RESULTS There were 109 patients with endoscopic biopsy negative GI lesions, including 61 males (56%) and 48 females (44%), with the mean age of 54 years. Sixty-three cases (57.8%) were proved to have malignant lesions, among them there were 15 cases with high-risk GIST as proved by FNA and excision biopsy. Forty-six cases (42.2%) were proved to be benign; among them there were 21 cases presented with non-high-risk GIST. Endoscopic ultrasound had a sensitivity of 96.8%, specificity of 89.1%, positive predictive value (PPV) of 92.4%, negative predictive value (NPV) of 95.3%, and accuracy of 93.6%. EUS-FNA had a sensitivity of 87.3%, specificity of 100%, PPV of 100%, NPV of 85.2%, and accuracy of 92.7%. CONCLUSION EUS with EUS-FNA is an accurate procedure in the diagnosis of GI tumors with negative endoscopic biopsies.
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Affiliation(s)
- Hussein Hassan Okasha
- Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt
| | - Mohamed Naguib
- Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt
| | - Mohamed El Nady
- Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt
| | - Reem Ezzat
- Department of Internal Medicine, Assiut University, Assiut, Egypt
| | - Emad Al-Gemeie
- Department of Pathology, National Cancer Institute (NCI), Cairo, Egypt
| | - Waleed Al-Nabawy
- Department of Internal Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Wael Aref
- Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt
| | - Ahmed Abdel-Moaty
- Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt
| | - Karim Essam
- Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt
| | - Ahmed Hamdy
- Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt
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Wyse JM, Battat R, Sun S, Saftoiu A, Siddiqui AA, Leong AT, Arturo Arias BL, Fabbri C, Adler DG, Santo E, Kalaitzakis E, Artifon E, Mishra G, Okasha HH, Poley JW, Guo J, Vila JJ, Lee LS, Sharma M, Bhutani MS, Giovannini M, Kitano M, Eloubeidi MA, Khashab MA, Nguyen NQ, Saxena P, Vilmann P, Fusaroli P, Garg PK, Ho S, Mukai S, Carrara S, Sridhar S, Lakhtakia S, Rana SS, Dhir V, Sahai AV. Practice guidelines for endoscopic ultrasound-guided celiac plexus neurolysis. Endosc Ultrasound 2017; 6:369-375. [PMID: 29251270 PMCID: PMC5752758 DOI: 10.4103/eus.eus_97_17] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objectives: The objective of guideline was to provide clear and relevant consensus statements to form a practical guideline for clinicians on the indications, optimal technique, safety and efficacy of endoscopic ultrasound guided celiac plexus neurolysis (EUS-CPN). Methods: Six important clinical questions were determined regarding EUS-CPN. Following a detailed literature review, 6 statements were proposed attempting to answer those questions. A group of expert endosonographers convened in Chicago, United States (May 2016), where the statements were presented and feedback provided. Subsequently a consensus group of 35 expert endosonographers voted based on their individual level of agreement. A strong recommendation required 80% voter agreement. The modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria were used to rate the strength of recommendations and the quality of evidence. Results: Eighty percent agreement was reached on 5 of 6 consensus statements, 79.4% agreement was reached on the remaining one. Conclusions: EUS-CPN is efficacious, should be integrated into the management of pancreas cancer pain, and can be considered early at the time of diagnosis of inoperable disease. Techniques may still vary based on operator experience. Serious complications exist, but are rare.
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Affiliation(s)
- Jonathan M Wyse
- Division of Gastroenterology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Robert Battat
- Division of Gastroenterology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Adrian Saftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy, Craiova, Romania
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ang Tiing Leong
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | | | - Carlo Fabbri
- Unit of Gastroenterology and Digestive Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital, Bologna, Italy
| | - Douglas G Adler
- Department of Internal Medicine, Division of Gastroenterology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Erwin Santo
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Everson Artifon
- Department of Surgery, Ana Costa Hospital, Sao Paulo, Brazil
| | - Girish Mishra
- Department of Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | | | - Jan Werner Poley
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jintao Guo
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Juan J Vila
- Endoscopy Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Linda S Lee
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, USA
| | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Specialty Hospital, Meerut, Uttar Pradesh, India
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marc Giovannini
- Endoscopic Unit, Institut Paoli-Calmettes, Marseille, France
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Mohamad Ali Eloubeidi
- Division of Gastroenterology, Northeast Alabama Regional Medical Center, Anniston, AL, USA
| | - Mouen A Khashab
- Department of Medicine and Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nam Q Nguyen
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | - Payal Saxena
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Peter Vilmann
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Pietro Fusaroli
- Department of Medical and Surgical Science, Gastroenterology Unit, Hospital of Imola, University of Bologna, Bologna, Italy
| | - Pramod Kumar Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Sammy Ho
- Division of Gastroenterology and Liver Diseases, Montefiore Medical Center, Bronx, New York, USA
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | - Subbaramiah Sridhar
- Section of Gastroenterology/Hepatology, Augusta University, Augusta, GA, USA
| | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vinay Dhir
- Baldota Institute of Digestive Sciences, Global Hospitals, Mumbai, Maharashtra, India
| | - Anand V Sahai
- Division of Gastroenterology, Center Hospitalier de l'Université de Montréal, Montreal, Canada
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Okasha HH, Amin M, Ezzat R, El-Nady M, Nagy A. Small bowel intussusception induced by a jejunal gastrointestinal stromal cell tumor diagnosed by endoscopic ultrasound. Endosc Ultrasound 2016; 5:346-347. [PMID: 27803910 PMCID: PMC5070295 DOI: 10.4103/2303-9027.191683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Hussein Hassan Okasha
- Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt
| | - Magdy Amin
- Department of Surgery, Maadi Military Hospital, Cairo, Egypt
| | - Reem Ezzat
- Department of Internal Medicine and Gastroenterology, Assiut University, Assiut, Egypt
| | - Mohamed El-Nady
- Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt
| | - Ahmed Nagy
- Department of Tropical Medicine, Cairo University, Cairo, Egypt
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Okasha HH, Amin HM, Al-Shazli M, Nabil A, Hussein H, Ezzat R. A duodenal gastrointestinal stromal tumor with a large central area of fluid and gas due to fistulization into the duodenal lumen, mimicking a large duodenal diverticulum. Endosc Ultrasound 2015; 4:253-6. [PMID: 26374586 PMCID: PMC4568640 DOI: 10.4103/2303-9027.163018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) can occur anywhere along the gastrointestinal tract especially the stomach and upper small bowel. They are usually solid, but cystic degeneration, necrosis, and focal hemorrhage have been described in larger tumors leading to central necrotic cavitation. The most sensitive marker of GIST is CD117 (c-kit). In computed tomography (CT) scan, it is often difficult to decide the origin of the primary tumor, especially in large GISTs. We report an incidental case of a large duodenal GIST fistulizing into the second part of the duodenum with a large amount of fluid and gas inside, mistaken for a cystic pancreatic neoplasm by CT and mistaken for a duodenal diverticulum by endoscopic ultrasound.
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Okasha HH, Ashry M, Imam HMK, Ezzat R, Naguib M, Farag AH, Gemeie EH, Khattab HM. Role of endoscopic ultrasound-guided fine needle aspiration and ultrasound-guided fine-needle aspiration in diagnosis of cystic pancreatic lesions. Endosc Ultrasound 2015; 4:132-6. [PMID: 26020048 PMCID: PMC4445171 DOI: 10.4103/2303-9027.156742] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 08/13/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The addition of fine-needle aspiration (FNA) to different imaging modalities has raised the accuracy for diagnosis of cystic pancreatic lesions. We aim to differentiate benign from neoplastic pancreatic cysts by evaluating cyst fluid carcinoembryonic antigen (CEA), carbohydrate antigen (CA19-9), and amylase levels and cytopathological examination, including mucin stain. PATIENTS AND METHODS This prospective study included 77 patients with pancreatic cystic lesions. Ultrasound-FNA (US-FNA) or endoscopic ultrasound-FNA (EUS-FNA) was done according to the accessibility of the lesion. The aspirated specimens were subjected to cytopathological examination (including mucin staining), tumor markers (CEA, CA19-9), and amylase level. RESULTS Cyst CEA value of 279 or more showed high statistical significance in differentiating mucinous from nonmucinous lesions with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 73%, 60%, 50%, 80%, and 65%, respectively. Cyst amylase could differentiate between neoplastic and nonneoplastic cysts at a level of 1043 with sensitivity of 58%, specificity of 75%, PPV of 73%, NPV of 60%, and accuracy of 66%. CA19-9 could not differentiate between neoplastic and nonneoplastic cysts. Mucin examination showed a sensitivity of 85%, specificity of 95%, PPV of 92%, NPV of 91%, and accuracy of 91% in differentiating mucinous from non-mucinous lesions. Cytopathological examination showed a sensitivity of 81%, specificity of 94%, PPV of 94%, NPV of 83%, and accuracy of 88%. CONCLUSION US or EUS-FNA with analysis of cyst CEA level, CA19-9, amylase, mucin stain, and cytopathological examination increases the diagnostic accuracy of cystic pancreatic lesions.
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Affiliation(s)
| | - Mahmoud Ashry
- Department of Internal Medicine, Assiut University, Assiut, Egypt
| | - Hala M K Imam
- Department of Internal Medicine, Assiut University, Assiut, Egypt
| | - Reem Ezzat
- Department of Internal Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Naguib
- Department of Internal Medicine, Cairo University, Oula, Giza, Egypt
| | - Ali H Farag
- Department of Internal Medicine, Cairo University, Oula, Giza, Egypt
| | - Emad H Gemeie
- Department of Pathology, National Cancer Institute, Oula, Giza, Egypt
| | - Hani M Khattab
- Department of Pathology, Cairo University, Oula, Giza, Egypt
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Abstract
Metastatic cancer to the pancreas is rare and accounts for less than 2% of all pancreatic malignancies. Renal cell cancer, malignant melanoma, lung, colon and breast carcinoma are among the few tumors known to metastasize to the pancreas. The pancreas is a rare site of solitary metastasis, but it is often involved in diffuse metastatic disease. We report a case of a female patient with a solitary mass in the neck of the pancreas following right nephrectomy performed 6 years previously for renal cell carcinoma (RCC). An endoscopic ultrasound (EUS) revealed a well-defined lesion in the neck of the pancreas. Patient underwent EUS-guided fine-needle aspiration and cytopathology confirmed the diagnosis of a metastatic RCC. Solitary pancreatic metachronous metastasis from RCC may rarely occur. The interval between nephrectomy and pancreatic metastasis may be long.
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Okasha HH, Mansour M, Attia KA, Khattab HM, Sakr AY, Naguib M, Aref W, Al-Naggar AAM, Ezzat R. Role of high resolution ultrasound/endosonography and elastography in predicting lymph node malignancy. Endosc Ultrasound 2014; 3:58-62. [PMID: 24949412 PMCID: PMC4063258 DOI: 10.4103/2303-9027.121252] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 08/21/2013] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The objective of this study is to evaluate the role of high resolution ultrasonography (US) and endoscopic ultrasound (EUS)-elastography in predicting malignant lymphadenopathy. PATIENTS AND METHODS This prospective study included 88 patients who underwent EUS or US examination of different groups of lymph nodes (LNs). The classification as benign or malignant based on the real time elastography pattern and the B-mode US/EUS images was compared with the final diagnosis obtained by EUS or US guided fine-needle aspiration cytology (FNAC), tru-cut biopsy or excisional biopsy and follow-up in benign lesions not indicated for biopsy for at least 12 months. RESULTS Regarding the echogenicity, 98.3% of the benign LNs were hyperechoic, 1.7% was hypoechoic while 89.7% of the malignant LNs were hypoechoic, 3.4% were heterogenous and 6.9% were hyperechoic. With cut-off value of 1.93, the sensitivity of longitudinal to transverse ratio was 73% and the specificity was 100%. Score 1 elastography had specificity of 100% in diagnosis of benign LNs, sensitivity was 76.3%, positive predictive value (PPV) was 100%, negative predictive value (NPV) was 84.7% while score 2 had a sensitivity of 60%, specificity of 31.5%, PPV of 15.3%, NPV of 79.3%. Score 3 had a sensitivity of 70.2%, specificity of 100%, PPV of 13.8%, NPV of 100% in detecting malignancy while score 4 had a sensitivity of 85.5%, specificity of 100%, PPV of 100%, NPV of 65.5%. CONCLUSION Elastography is a promising diagnostic modality that may complement standard ultrasound and EUS and help guide FNAC during staging of LNs.
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Affiliation(s)
- Hussein Hassan Okasha
- Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt
| | - Mona Mansour
- Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt
| | - Khaled Ahmed Attia
- Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt
| | | | | | - Mohamed Naguib
- Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt
| | - Wael Aref
- Department of Internal Medicine and Gastroenterology, Cairo University, Cairo, Egypt
| | | | - Reem Ezzat
- Department Internal Medicine and Gastroenterology, Assiut University, Assiut, Egypt
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Okasha HH, Naga MI, Esmat S, Naguib M, Hassanein M, Hassani M, El-Kassas M, Mahdy RE, El-Gemeie E, Farag AH, Foda AM. Endoscopic Ultrasound-Guided Fine Needle Aspiration versus Percutaneous Ultrasound-Guided Fine Needle Aspiration in Diagnosis of Focal Pancreatic Masses. Endosc Ultrasound 2014; 2:190-3. [PMID: 24949394 PMCID: PMC4062270 DOI: 10.4103/2303-9027.121239] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/22/2013] [Indexed: 01/05/2023] Open
Abstract
Objective: Pancreatic carcinoma is one of the leading cancer morbidity and mortality world-wide. Controversy has arisen about whether the percutaneous approach with computed tomography/ultrasonography-guidance fine needle aspiration (US-FNA) or endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the preferred method to obtain diagnostic tissue. Our purpose of this study is to compare between the diagnostic accuracy of EUS-FNA and percutaneous US-FNA in diagnosis of pancreatic cancer. Patients and Methods: A total of 197 patients with pancreatic masses were included in the study, 125 patients underwent US-FNA (Group 1) and 72 patients underwent EUS-FNA (Group 2). Results: EUS-FNA has nearly the same accuracy (88.9%) as US-FNA (87.2%) in diagnosis of pancreatic cancer. The sensitivity, specificity, positive predictive value and negative predictive value for EUS-FNA was 84%, 100%, 100%, 73.3% respectively. It was 85.5%, 90.4%, 94.7%, 76% respectively for US-FNA. EUS-FNA had a lower complication rate (1.38%) than US-FNA (5.6%). Conclusion: EUS-FNA has nearly the same accuracy as US-FNA of pancreatic masses with a lower complication rate.
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Affiliation(s)
| | - Mazen Ibrahim Naga
- Internal Medicine and Gastroenterology Department, Cairo University, Egypt
| | - Serag Esmat
- Internal Medicine and Gastroenterology Department, Cairo University, Egypt
| | - Mohamed Naguib
- Internal Medicine and Gastroenterology Department, Cairo University, Egypt
| | - Mohamed Hassanein
- National Hepatology and Tropical Medicine Research Institute (NHTMRI); Assiut, Egypt
| | - Mohamed Hassani
- National Hepatology and Tropical Medicine Research Institute (NHTMRI); Assiut, Egypt
| | - Mohamed El-Kassas
- National Hepatology and Tropical Medicine Research Institute (NHTMRI); Assiut, Egypt
| | - Reem Ezzat Mahdy
- Internal Medicine and Gastroenterology Department, Assiut University, Egypt
| | - Emad El-Gemeie
- Pathology Department, National Cancer Institute (NCI), Egypt
| | - Ali Hassan Farag
- Internal Medicine and Gastroenterology Department, Cairo University, Egypt
| | - Ayman Mohamed Foda
- Internal Medicine and Gastroenterology Department, Cairo University, Egypt
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Okasha HH, Al-Bassiouni F, El-Ela MA, Al-Gemeie EH, Ezzat R. A retroperitoneal neuroendocrine tumor in ectopic pancreatic tissue. Endosc Ultrasound 2014; 2:168-70. [PMID: 24949389 PMCID: PMC4062254 DOI: 10.7178/eus.06.0012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 07/01/2013] [Indexed: 11/06/2022] Open
Abstract
Ectopic pancreas is the relatively uncommon presence of pancreatic tissue outside the normal location of the pancreas. We report a case of abdominal pain due to retroperitoneal neuroendocrine tumor arising from heterotopic pancreatic tissue between the duodenal wall and the head of the pancreas. Patient underwent surgical enucleation of the tumor.
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Affiliation(s)
| | | | | | | | - Reem Ezzat
- Department of Gastroenterology, Assiut University, Cairo, Egypt
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Okasha HH, Ramadan F, El-Saadany M, Al-Rabat M, Naga MI, El-Badri A, Fouda A, Hashem AM. Endosonography as a predictive tool for first oesophagogastric variceal bleeding. Arab J Gastroenterol 2010. [DOI: 10.1016/j.ajg.2010.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Variceal bleeding is a serious complication with a mortality rate that ranges from 20% to 50%. Patients who have variceal hemorrhage usually are treated by endoscopic injection sclerotherapy or elastic band ligation to eradicate the varices. Endoloop ligation is a newly developed technique for achieving hemostasis and variceal eradication. This study compared endoloop ligation with elastic band ligation in patients with acute esophageal variceal bleeding. METHODS Fifty patients with acute esophageal variceal bleeding were recruited: 25 were treated by elastic band ligation and 25 by endoloop ligation. RESULTS Although the number of patients in whom bleeding recurred during a follow-up period of 6 months was smaller in the endoloop group (12%) vs. the band group (28%), this difference was not statistically significant. Furthermore, no statistically significant difference was found between the two groups with respect to the number of patients in whom variceal eradication was achieved, the number of treatment sessions required for variceal eradication, or the frequency of variceal recurrence. The total cost for variceal obliteration by endoloop ligation was 342 dollars per patient, whereas, the total cost of variceal eradication by elastic band ligation was 356 dollars per patient. The endoloop had certain technical advantages over band application: a better field of vision, tighter application, good results with junctional varices, and a lack of strain exerted by the device on the endoscope. CONCLUSIONS Endoloop ligation is a promising new technique for management of patients with bleeding esophageal varices.
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Affiliation(s)
- Mazen Ibrahim Naga
- Department of Internal Medicine and Gastroenterology, Kasr El-Aini Hospitals, Cairo University, Egypt
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Abstract
BACKGROUND GI tuberculosis is a diagnostic challenge, particularly in the absence of evidence of pulmonary infection. It may mimic many other abdominal diseases such as other infectious processes, tumors, and Crohn's disease. In the absence of positive laboratory and radiologic tests, the diagnosis is often established definitively by obtaining a surgical specimen. Colonoscopy, however, has been used successfully to diagnose the disease and thus avoid the morbidity and mortality associated with exploratory laparotomy. METHODS An evaluation was conducted of colonoscopic features in 10 patients with colonic tuberculosis. OBSERVATIONS In all cases there was ileocecal involvement; total colonic involvement was found in only 1 case. The colonoscopic appearance included the following: ulcerated lesions, sessile firm polyps, masses, and small diverticula, ranging from 3 to 5 mm in diameter. In 5 of our patients the diagnosis was confirmed bacteriologically, in 3 with endoscopic biopsy material, and in 2 by sputum examination. In all cases antituberculous therapy produced remarkable symptom and endoscopic improvement. CONCLUSION This report highlights the importance of colonoscopy in the diagnosis of tuberculous involvement of the GI tract.
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Affiliation(s)
- M I Naga
- Kasr El-Aini Hospitals and Cairo University, Cairo, Egypt
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