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- ItemAcesso aberto (Open Access)Eficácia e complicações da drenagem de pseudocistos de pâncreas guiada por ecoendoscopia(Universidade Federal de São Paulo (UNIFESP), 2019-05-30) Sousa, Giovana Biasia De [UNIFESP]; Libera Junior, Ermelindo Della [UNIFESP]; Nakao, Frank Shigueo [UNIFESP]; http://lattes.cnpq.br/8755026089314875; http://lattes.cnpq.br/0528784228011000; http://lattes.cnpq.br/8684478554601684; Universidade Federal de São Paulo (UNIFESP)Introduction: Pancreatic pseudocyst refers specifically to a fluid collection in the peripancreatic tissues that it surrounded by a well defined wall and contains essentially no solid material. It has been successfully treated by EUS-guided drainage using different stents. Aims: to evaluate the safety and efficacy of EUS-guided pancreatic pseudocyst drainage using plastic double-pigtail stents in a tertiary hospital. Patients and Methods: we reviewed the results of 9 patients (median age 42 years [range: 14 – 79]; 67% male) with symptomatic pancreatic pseudocyst. Indication EUS-guided drainage was abdominal pain (8), gastric outlet obstruction (4) and biliary obstruction (1). The etiology was acute pancreatitis (4), chronic pancreatitis (3) and blunt abdominal trauma (2). Pseudocyst mean size was 9,8cm (range 5,3-13,5cm). Only patients presenting pancreatic pseudocyst according to The Revised Atlanta Classification were included in this study. Pseudocysts were treated with EUS-guided cystogastrostomy (8) and cystoduodenostomy (1). Overall recorded outcomes were technical success rate, clinical success rate, minor and major adverse events, mortality and recurrence. The criterion for stent removal was pseudocyst resolution on computed tomography scan. Results: Technical success rate was 100% (6 patients with 2 double-pigtail plastic stents and 3 patients with only one double-pigtail plastic stent). Overall clinical success and image pseudocyst resolution 4 – 6 months after initial drainage was 89% (8/9). Minor adverse events occurred in 3/9 patients (33%): false guidewire path with no clinical consequence, early stent migration and stent occlusion. There were no major events adverses. There was a recurrence in (1/9 patients) and no mortality. Conclusions: We concluded that EUS-guided transmural drainage of pancreatic pseudocyst using plastic double-pigtail stents is a safe procedure, resulting in clinical improvement and pseudocyst resolution in most of the patients.
- ItemAcesso aberto (Open Access)Estudo prospectivo e comparativo do escovado obtido pela CPER à ecoendoscopia associada à punção aspirativa com agulha fina (EE-PAAF) no diagnóstico diferencial das estenoses biliares(Colégio Brasileiro de Cirurgiões, 2010-06-01) Novis, Monica; Ardengh, José Celso; Libera, Ermelindo Della; Nakao, Frank Shigueo; Ornellas, Laura Cota; Santo, Giulio Cesare [UNIFESP]; Venco, Filadelfio [UNIFESP]; Ferrari, Angelo Paulo [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate and to compare the diagnostic yield of ERCP brush cytology (ERCP) and EUS-FNA in patients with biliary strictures and evaluates the agreement between general pathologists (GP) and expert GI pathologists (GIP) in the final diagnosis of biliary strictures. METHODS: Patients with biliary strictures documented by ERCP were included. Brush cytology was performed and during EUS, only visible mass lesions or localized bile duct wall thickening were aspirated. The gold standard method for diagnosis was surgical histology and/or follow-up. Tissue sampling results were: malignant, suspicious, atypical, insufficiently or benign. Specimens were interpreted by GP and GIP, blinded for prior tests results. RESULTS: 46 patients were included. Final diagnosis was malignancy in 37 (26 pancreatic - 11 biliary) and benign in 9 (8 chronic pancreatitis - 1 common bile duct inflammatory stricture). Sensitivity and accuracy for ERCP brush cytology were 43.2% and 52.2% for GP and 51.4% and 58.7% for GIP. Sensitivity and accuracy for EUS-FNA were 52.8% and 58.5%, respectively for GP and 69.4% e 73.2% for GIP. In comparison, the combination of brush cytology and EUS-FNA demonstrated higher sensitivity and accuracy for both GP (64.9% and 69.6%, respectively) and GIP (83.8% and 84.8%, respectively) and improved agreement with final diagnosis for both (mostly for GIP). CONCLUSION: Both, ERCP brush cytology and EUS-FNA has a similar yield for the diagnosis of biliary strictures. However, the combination of these methods results in an improved diagnostic accuracy. In addition, GIP might be expected to interpret specimens with greater accuracy than GP.
- ItemSomente MetadadadosNew Trends in Diffusion-Weighted Magnetic Resonance Imaging as a Tool in Differentiation of Serous Cystadenoma and Mucinous Cystic Tumor: A Prospective Study(Karger, 2011-01-01) Schraibman, Vladimir [UNIFESP]; Goldman, Suzan Menasce [UNIFESP]; Ardengh, Jose Celso; Goldenberg, Alberto [UNIFESP]; Lobo, Edson [UNIFESP]; Linhares, Marcelo Moura [UNIFESP]; Gonzales, Adriano Mizziara [UNIFESP]; Abdala, Nitamar [UNIFESP]; Abud, Thiago Giansante [UNIFESP]; Ajzen, Sergio Aron [UNIFESP]; Jackowsky, Andrea; Szejnfeld, Jacob [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Fundacao Inst Pesquisa & Estudo Diagnost ImagemBackground/Aims: Pancreatic cystic lesions are increasingly being recognized. Magnetic resonance imaging (MRI) is the method that brings the greatest amount of information about the morphologic features of pancreatic cystic lesions. To establish if diffusion-weighted MRI (DW-MRI) can be used as a tool to differentiate mucinous from nonmucinous lesions. Methods: Fifty-six patients with pancreatic cystic lesions (benign, n = 46; malignant, n = 10) were prospectively evaluated with DW-MRI in order to differentiate mucinous from nonmucinous lesions. Final diagnosis was obtained by follow-up (n = 31), surgery (n = 16) or endoscopic ultrasound-guided fine needle aspiration (n = 9). Serous cystadenoma was identified in 32 (57%) patients. Results: the threshold value established for the differentiation of mucinous from nonmucinous lesions was 2,230.06 s/mm(2) for ADC of 700. DWI-MRI behavior between mucinous and nonmucinous groups revealed sensitivity, specificity, positive predictive value, negative predictive value and accuracy to be 80, 98, 92, 93 and 93%, respectively (p<0.01, power of sample = 1.0). in the comparison of the diffusion behavior between mucinous (n = 13) and serous (n = 32) lesions, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 100, 97, 92, 100 and 98%, respectively (p<0.01, power of sample = 1.0). the results of endoscopic ultrasound-guided fine needle aspiration were similar to those of DW-MRI. Conclusions: DW-MRI can be included as part of the array of tools to differentiate mucinous from nonmucinous lesions and can help in the management of pancreatic cystic lesions. Copyright (C) 2011 S. Karger AG, Basel and IAP