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Noia JL, Mejuto R, Oria I, De la Iglesia-García D, Villaverde A, Voces A, Pizzala J, Iglesias-García J, Urgiles D, Marcolongo M, Mazza O, Dominguez-Muñoz E. Rapid diagnosis of mucinous cystic pancreatic lesions by on-site cyst fluid glucometry. Surg Endosc 2021; 36:2473-2479. [PMID: 33988771 DOI: 10.1007/s00464-021-08532-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/30/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Available intracystic biomarkers show a limited accuracy for characterizing cystic pancreatic lesions (CPL). Glucose is an attractive alternative due to its availability, low cost and the possibility of on-site quantification by glucometry. AIM To evaluate the diagnostic accuracy of on-site glucometry from samples obtained by EUS-FNA in the differential diagnosis between mucinous from non-mucinous CPL. METHODS Retrospective, multicentre, cross-sectional study of patients who underwent EUS-FNA of a CPL. A derivation and a validation cohorts were evaluated. Intracystic glucose was quantified by on-site glucometry and colorimetry in the lab. Final diagnosis was based on surgical specimens or global evaluation of clinical and imaging data, cytology and intracystic CEA. Diagnostic accuracy was based on Receiver Operating Curve (ROC) curve analysis. Intraclass correlation coefficient (ICC) between on-site and lab glucose levels was calculated. RESULTS Seventy two patients were finally analysed (40 in the derivation cohort and 32 in the validation cohort). Intracystic glucose levels by on-site glucometry was 12.3 ± 28.2 mg/dl for mucinous CPL and 103.3 ± 58.2 mg/dl for non-mucinous CPL, p < 0.001. For an optimal cut-off point of 73 mg/dl, on-site glucose had a sensitivity, specificity, and positive and negative predictive value for the diagnosis of mucinous CPL of 0.89, 0.90, 0.94, 0.82 respectively in the derivation cohort, and 1.0, 0.71, 0.91, 1.0 respectively in the validation cohort. Correlation of on-site and lab glucose quantification was very high (ICC = 0.98). CONCLUSION On-site glucometry is a feasible, accurate and reproducible method for the characterization of CPL after EUS-FNA. It shows an excellent correlation with laboratory glucose values. Registration number: 2019/612.
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Affiliation(s)
- José Lariño Noia
- Department of Gastroenterology and Hepatology, Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, C/Choupana s/n, 15706, Santiago de Compostela, Spain.
| | - Rafael Mejuto
- Department of Gastroenterology and Hepatology, Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, C/Choupana s/n, 15706, Santiago de Compostela, Spain
| | - Inés Oria
- Department of Gastroenterology and Hepatology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Daniel De la Iglesia-García
- Department of Gastroenterology and Hepatology, Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, C/Choupana s/n, 15706, Santiago de Compostela, Spain
| | - Augusto Villaverde
- Department of Gastroenterology and Hepatology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Alba Voces
- Department of Gastroenterology and Hepatology, Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, C/Choupana s/n, 15706, Santiago de Compostela, Spain
| | - Juan Pizzala
- Department of Gastroenterology and Hepatology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Julio Iglesias-García
- Department of Gastroenterology and Hepatology, Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, C/Choupana s/n, 15706, Santiago de Compostela, Spain
| | - Dalila Urgiles
- Department of Gastroenterology and Hepatology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Mariano Marcolongo
- Department of Gastroenterology and Hepatology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Oscar Mazza
- Department of Gastroenterology and Hepatology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Enrique Dominguez-Muñoz
- Department of Gastroenterology and Hepatology, Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, C/Choupana s/n, 15706, Santiago de Compostela, Spain
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Alvarez-Sánchez MV, Luna OB, Oria I, Marchut K, Fumex F, Singier G, Salgado A, Napoléon B. Feasibility and Safety of Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) for Malignant Biliary Obstruction Associated with Ascites: Results of a Pilot Study. J Gastrointest Surg 2018; 22:1213-1220. [PMID: 29532359 DOI: 10.1007/s11605-018-3731-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/26/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND It has been suggested that EUS-BD may be a feasible and safer alternative to percutaneous transhepatic biliary drainage (PTBD) after failed ERCP in patients with ascites. To date, no study has specifically evaluated the performance of EUS-BD in this context. METHODS Retrospective analysis was done for patients with and without ascites who underwent EUS-BD for malignant biliary obstruction after failed ERCP between July 2010 and September 2014. Complications and technical and clinical successes between the two groups were compared. RESULTS A total of 31 patients were included: 20 patients without ascites (group 1) and 11 with ascites (group 2). Nineteen patients underwent EUS-hepaticogastrostomy (six in group 2), and 12 underwent EUS-choledochoduodenostomy (five in group 2). Technical success was achieved in all patients. Clinical success was observed in 95% (n = 19) in group 1 and 64% (n = 7) in group 2 (p = 0.042). In three out of four patients without clinical success in group 2, the follow-up period was not long enough to observe the clinical response because of early death within the 2 weeks after EUS-BD secondary to disease progression or preprocedural unresponsive sepsis. No significant differences were observed between groups 1 and 2 either in the overall rates of procedural-related complications (20 and 9%, respectively, p = 0.63) or in the rates of major complications (15 vs 9%, respectively, p = 0.639). Stent migration occurred in one patient in each group, intra- or post-procedural bleeding occurred in two patients in group 1, which was conservatively managed, and one patient in group 1 presented biliary leakage. Stent patency and the number of re-interventions were not significantly different. CONCLUSIONS EUS-BD is technically feasible in patients with ascites. Our results suggest that EUS-BD may be a clinically effective and safe alternative after failed ERCP in patients with ascites.
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Affiliation(s)
- María Victoria Alvarez-Sánchez
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France.
- Department of Gastroenterology, Complejo Hospitalario de Pontevedra, Pontevedra, Spain.
- Instituto de Investigación Sanitaria Galicia Sur (IISGS), Pontevedra, Spain.
| | - O B Luna
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Clinica Echoendo, Rio de Janeiro, Brazil
| | - I Oria
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Department of Gastroenterology, Hospital Italiano, Buenos Aires, Argentina
| | - K Marchut
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
- Department of Gastroenterology, Hôpital Maisonneuve-Rosemont, Montréal, Canada
| | - F Fumex
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - G Singier
- Department of Surgery, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - A Salgado
- Instituto de Investigación Sanitaria Galicia Sur (IISGS), Pontevedra, Spain
| | - B Napoléon
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
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Mahler MA, Prieto RG, Oria I, Villa-Gómez G, Vidales G, Perez-Miranda M. Single-session EUS-guided hepaticogastrostomy and dual-scope gastroenterostomy: a modified technique for palliative double endoscopic biliary and gastric bypass. Endoscopy 2018; 50:78-79. [PMID: 29041017 DOI: 10.1055/s-0043-119972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
| | | | - Inés Oria
- Gastroenterology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Guido Villa-Gómez
- Endoscopy Unit, Instituto de gastroenterología Boliviano Japonés, La Paz, Bolivia
| | - Gustavo Vidales
- Endoscopy Unit, Instituto de gastroenterología Boliviano Japonés, La Paz, Bolivia
| | - Manuel Perez-Miranda
- Gastroenterology Department, Hospital universitario "Rio Hortega", Valladolid, Spain
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Alvarez-Sanchez MV, Oria I, Luna OB, Pialat J, Gincul R, Lefort C, Bourdariat R, Fumex F, Lepilliez V, Scoazec JY, Salgado-Barreira A, Lemaistre AI, Napoléon B. Can endoscopic papillectomy be curative for early ampullary adenocarcinoma of the ampulla of Vater? Surg Endosc 2016; 31:1564-1572. [PMID: 27530895 DOI: 10.1007/s00464-016-5141-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/18/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The therapeutic role of endoscopic papillectomy (EP) for early ampullary cancer (AC) is still controversial. The aim of the present study was to evaluate the curative potential of EP for early AC and to identify predictors of lymph node metastases (LNMs). METHODS We retrospectively reviewed 173 patients who were prospectively included in a database and who underwent EP between 1999 and 2013. Adenocarcinoma was present in 28 resected specimens. An additional surgery was proposed in cases of duodenal submucosal infiltration, duct ingrowth, R1 resection or lymphovascular invasion. Clinicopathological information and outcomes were collected, and predictors of LNMs were evaluated. RESULTS Duodenal submucosal invasion was present in 16/28 cases and LNMs, in 9/28 cases. ACs of the biliopancreatic subtype were smaller (NS); 100 % had submucosal invasion, and 71 % had LNMs. Smaller tumour size, biliopancreatic subtype and submucosal invasion were significantly correlated with LNMs (p < 0.028, p < 0.028 and p < 0.014). Predictive factors of LNMs in the multivariate analysis were submucosal invasion and tumour size (OR 0.032, p < 0.023 and OR 0.711, p < 0.035). EP was curative in 100 % of cancers with R0 resection and no evidence of submucosal or lymphovascular invasion. CONCLUSION EP may be curative for patients with AC limited to the duodenal mucosa or the sphincter of Oddi without lymphovascular invasion. Due to the presence of more invasive stages at diagnosis, EP may not be curative for ACs of the biliopancreatic subtype. The significance of tumour size is limited by other confounders, such as the histological subtype.
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Affiliation(s)
- María-Victoria Alvarez-Sanchez
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, 55 avenue Jean Mermoz, 69008, Lyon, France
- Department of Gastroenterology, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
| | - Inés Oria
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, 55 avenue Jean Mermoz, 69008, Lyon, France
- Department of Gastroenterology, Hospital Italiano, Buenos Aires, Argentina
| | - Olivia B Luna
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, 55 avenue Jean Mermoz, 69008, Lyon, France
- Clinica Echoendo, Rio de Janeiro, Brazil
| | - Jean Pialat
- Office of Pathology, 41, Allée des Cyprès, Limonest, France
| | - Rodica Gincul
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, 55 avenue Jean Mermoz, 69008, Lyon, France
- Department of Gastroenterology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Christine Lefort
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, 55 avenue Jean Mermoz, 69008, Lyon, France
| | - Raphael Bourdariat
- Department of Digestive Surgery, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Fabien Fumex
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, 55 avenue Jean Mermoz, 69008, Lyon, France
| | - Vincent Lepilliez
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, 55 avenue Jean Mermoz, 69008, Lyon, France
| | - Jean Yves Scoazec
- Department of Pathology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | | | | | - Bertrand Napoléon
- Department of Gastroenterology, Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, 55 avenue Jean Mermoz, 69008, Lyon, France.
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