[Show abstract][Hide abstract] ABSTRACT: Contrast harmonic endoscopic ultrasound (CH-EUS) was recently introduced to clinical practice; its reproducibility among endosonographers is unknown. Our aim was to assess the interobserver agreement (IA) in CH-EUS.
Fifteen endosonographers (eight experienced and seven non-experienced) from 11 Italian EUS centers evaluated 80 video-cases (40 solid pancreatic lesions, 20 pancreatic cystic lesions and 20 submucosal lesions) of CH-EUS, according to the degree of enhancement, the pattern of distribution and the washout of the contrast agent. IA within each group and between the two groups of observers was assessed with the Fleiss kappa statistic.
Overall IA was moderate for the uptake and fair for the pattern of distribution and the washout. In solid pancreatic lesions, IA was moderate for the uptake and fair for the pattern and the washout. In cystic pancreatic lesions, IA was uniformly moderate for the assessment of uptake, slight for the pattern and fair for the washout. In submucosal tumors, IA was substantial for the uptake, slight for the pattern and fair for the washout. Non-experienced endosonographers demonstrated, in most cases, comparable IA with the experienced ones.
Interobserver agreement among endosonographers for CH EUS was satisfactory. In particular, overall IA varied from slight to substantial, being fair in the majority of cases. Inherent structural features of the lesions, as well as technical differences between the variables assessed, could have accounted for the fluctuation of the results. Outcomes of IA were reproducible between experienced and non-experienced endosonographers.
Journal of Gastroenterology and Hepatology 03/2012; 27(6):1063-9. DOI:10.1111/j.1440-1746.2012.07115.x · 3.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Rupture of the spleen after colonoscopy is a rare but dangerous complication; up to now only a few cases have been reported in the literature. This complication is more frequent in patients who have previously undergone abdominal surgery and after operative colonoscopies. This case report describes a 64-year-old man who complained of abdominal pain and dyspnoea some hours after a colonoscopy. Laboratory exams showed anaemia; the patient also developed hypotension and tachycardia; a CT scan revealed a splenic laceration with haemoperitoneum. A laparotomic splenectomy was successfully carried out.
Chirurgia italiana 09/2007; 59(5):755-7. DOI:10.1097/TA.0b013e31802dc947
[Show abstract][Hide abstract] ABSTRACT: Endoscopic ultrasonography (EUS) is a relatively new diagnostic technique; although it has greatly shown its utility in many diseases, its diffusion is still limited. In very few European academic centers EUS is included in basic endoscopic gastrointestinal (GI) fellowship; for this reason endoscopists interested in EUS generally attend intensive EUS workshops, where available. Recently, in some university centers, for example in Italy, long-term training courses in advanced endoscopy, including EUS, have been organized. These educational periods comprehend an extensive calendar of didactic lectures, live procedures, and hands-on training. Topics taught generally are: basics of ultrasound, indications, risks and expected outcome of EUS, normal/pathologic EUS anatomy, management of procedure-related complications, and management of sedation during endoscopy. After a mean of 250–500 supervised EUS exams, the trainee is expected to achieve a good competence in this technique.
[Show abstract][Hide abstract] ABSTRACT: The most common primary lymphoma of the gastrointestinal tract is B-cell lymphoma arising from mucosa-associated lymphoid tissue known as MALT lymphoma. Although the majority of these lesions affect the stomach and are associated with Helicobacter pylori organisms, sites other than the gastrointestinal tract may be affected. This case report describes a patient with concomitant laryngeal MALT lymphoma and Helicobacter pylori-related gastric MALT lymphoma derived from the same clone as confirmed by PCR. Treatment of Helicobacter pylori infection in this patient using antibiotics led to regression of both lesions. This patient remains in remission at 46-month follow-up. This is the first case report on the regression of a laryngeal MALT lymphoma after Helicobacter pylori eradication. We suggest that all patients presenting with extragastric MALT lymphoma should undergo upper gastrointestinal endoscopy with gastric biopsies for the determination of Helicobacter pylori status and presence of concomitant gastric MALT lymphoma, followed by a course of anti-Helicobacter pylori antibiotic therapy. Nonresponders may subsequently be considered for surgery and/or chemo/radiation therapy.
[Show abstract][Hide abstract] ABSTRACT: Anti-Helicobacter pylori therapy has been reported to cause regression of low-grade gastric mucosa-associated lymphoid tissue lymphoma in a high percentage of patients. However, in some patients, these lesions persist despite antibiotic treatment.
To determine the various endosonographic findings that may predict the regression of low-grade gastric mucosa-associated lymphoid tissue lymphoma post-antibiotics.
Seventy-six patients with Helicobacter pylori-positive gastric mucosa-associated lymphoid tissue lymphoma were studied. Follow-up data were available on 51 patients. All patients were treated with antibiotics. Participants underwent pre- and post-anti-Helicobacter pylori therapy endoscopy with gastric biopsies, followed by endoscopic ultrasonography examination of the stomach.
Helicobacter pylori was eradicated in 45 of 51 (88%) patients. At the 2-year follow-up, complete regression of mucosa-associated lymphoid tissue lymphoma was seen in 28 of 51 (55%) patients: 12 of 16 (75%) patients in stage T1m N0, 11 of 19 (58%) patients in stage T1sm N0, four of eight (50%) patients in stages T1m N1 and T1sm N1, and one of four (25%) patients in stage T2 N0. None of the stage T2 N1 patients achieved clinical regression.
Endoscopic ultrasonography evaluation of gastric mucosa-associated lymphoid tissue lymphoma plays a pivotal role in the initial staging and post-treatment follow-up evaluation of these lesions. Accurate staging is essential in the determination of the optimal treatment modality.
[Show abstract][Hide abstract] ABSTRACT: Endoscopic ultrasound imaging of mediastinum, gastrointestinal tract and pancreas, and endoscopic ultrasound-guided fine-needle aspiration of suspicious lesions, have now been available for several years. Although many papers have been published on endoscopic ultrasonography, a comprehensive overview of the subject matter presented has not yet been carried out. An extensive survey of the literature on endoscopic ultrasonography since its inception in the 1980 s was conducted in this study; key points are summarized.
A computer-based PubMed search system was used to retrieve all available abstracts pertaining to endoscopic ultrasound from 1980 to the present. Data were collected concerning the impact factor, the various EUS instruments and fine-needle aspiration biopsy techniques used, and the subject matter, as well as the journals publishing the abstracts.
A total of 1259 articles were published in 65 journals: 440 (35 %) Western European studies, 404 (32 %) American studies, and 321 (26 %) Japanese studies were retrieved. The total and average impact factor per paper was highest for American papers, followed by European papers and Japanese papers. Forty-seven percent of the papers were published in Gastrointestinal Endoscopy and Endoscopy. The most frequently discussed topics concerned the staging of various malignancies, including esophageal, gastric, pancreatic, and colorectal cancer. The average sample size per paper was in the range 25 - 50. The various types of study included retrospective inquiries (25 %), reviews (24 %), prospective studies (17 %), and case reports (15 %).
Over the course of the past 20 years, there has been a progressive increase in the number of publications pertaining to endoscopic ultrasonography. Large-scale prospective studies are now needed to validate earlier reports. In addition, the diagnostic and therapeutic role of endoscopic ultrasound needs to be more widely publicized among physicians in all health-care fields, so that appropriate patients may be referred.