Endoscopic Ultrasonography Clinical Impact. Giancarlo Caletti. Gastroenterologia Università di Bologna. Caletti

Size: px
Start display at page:

Download "Endoscopic Ultrasonography Clinical Impact. Giancarlo Caletti. Gastroenterologia Università di Bologna. Caletti"

Transcription

1 Clinical Impact Giancarlo Gastroenterologia Università di Bologna AUSL di Imola,, Castel S. Pietro Terme (BO)

2 1982

3 Indications Diagnosis of Submucosal Tumors (SMT) Staging of Neoplasms Evaluation of Pancreato-Biliary Region Therapeutic applications??

4 Indications Staging of neoplasms Esophageal cancer Gastric lymphoma Gastric cancer Non small cell lung cancer Rectal cancer

5 Indications Staging of neoplasms Esophageal cancer Extremely useful for staging and triage the initial therapy

6 Staging of neoplasms: More complex Less complex Esophagus / Mediastinum Management plan changes post EUS Surgery to neodjuvant therapy and surgery (n=1) Chemotherapy to surgery (n=1) Clinical follow-up (palliative) to neodjuvant therapy and surgery (n=1) Diagnostic endoscopy to endoscopic mucosal resection (n=1) Imaging follow-up to chemotherapy (n=1) Surgery to radiation and/or chemotherapy (n=3) Surgery to imaging and/or endoscopic follow-up (n=1) Imaging and/or endoscopic follow-up to clinical follow-up (n=3) Number of EUS FNA leading to management change 12/22 (56%) 5/12 (42%) 7/12 (58%) 4/4 (100%) Shah et al. Clin Gastroenterol Hepatol 2004

7 Indications Staging of neoplasms Esophageal cancer T1m, N0 T1sm/T2, N0 T3, N1 Neoadjuvant Ch RX Endoscopy / Surgery Surgery Surgery T4, N1 Palliation

8 Staging of neoplasms: stomach Management plan changes post-eus More complex 9/15 (60%) 2/9 (22%) Imaging follow-up to surgery (n=1) Endoscopic follow-up to endoscopic mucosal resection (n=1) Less complex 7/9 (78%) Surgery to endoscopic mucosal resection (n=1) Surgery to clinical follow-up (n=1) Imaging and/or endoscopic follow-up to clinical follow-up (n=5) Number of EUS FNA leading to a management change 0/1 (0%) Shah et al. Clin Gastroenterol Hepatol 2004

9 Impact of EUS on Surgery in UGI Cancer Treatment decisions were changed in 34% based on EUS results, and the majority of these changes were toward nonsurgical and palliative treatments (85%) Mortensen et al. Surg Endosc 2007

10 Staging of neoplasms: rectal Management plan changes post-eus More complex 4/10 (40%) 2/4 (50%) Surgery alone to neoadjuvant therapy and surgery (n=2) Less complex 2/4 (50%) Surgery to chemotherapy Neoadjuvant therapy and surgery to surgery alone (n=1) Number of EUS FNA leading to management change 1/2 (50%) Shah et al. Clin Gastroenterol Hepatol 2004

11 EUS: T1m

12 Indications for EUS Evaluation of pancreato-biliary region Pancreatic and periampullary cancer Acute Pancreatitis Choledocholithiasis Neuroendocrine tumors Pancreatic cysts Chronic pancreatitis

13 EUS vs MRCP in pancreatobiliary diseases: prospective comparison PPV NPV Malignancy EUS 98% 100% MRCP 96% 97.4% Choledocholithiasis EUS 78% 94% MRCP 92% 91% Fernandez-Esparrach et al. Am J Gastroenterol 2007

14 Pancreatic cancer meta-analysis: analysis: EUS sensitivity for vascular invasion Puli et al. Gastrointest Endosc 2007

15 Pancreatic cancer meta-analysis: analysis: EUS specificity for vascular invasion Puli et al. Gastrointest Endosc 2007

16 Negative predictive value of EUS for Pancreatic Cancer NPV of EUS was 100% Retrospective review of 693 pts. (Jan 1999-Mar 2003) suspected of having PC 155 pts. were found to have a normal pancreas No pts. developed PC during follow up (mean 25 months) No further work-up was required in 88% of pts. In pts. with a clinical suspicion of PC, EUS should be considered as the initial diagnostic modality Klapman et al. Am J Gastroenterol 2005

17 Clinical impact Management plan changes post-eus More complex ERCP to surgery (n=1) Radiology guided biopsy to radiation and/or chemotherapy (n=1) Imaging to surgery (n=2) Imaging to ERCP (n=2) Less complex Surgery to clinical follow-up (n=3) Surgery to radiation and or chemotherapy (n=4) ERCP to clinical follow-up (n=2) ERCP to imaging follow-up (n=3) Radiology guided biopsy examination to imaging follow-up (n=2) Imaging to clinical follow-up (n=1) Number of EUS FNA leading to management change 21/43 (49%) 6/21 (29%) 15/21 (71%) 4/13 (31%) Shah et al. Clin Gastroenterol Hepatol 2004

18 EUS-Sonovue Sonovue for pancreatic cancer Sonovue: early venous phase Cytology: adenocarcinoma et al. Unsubmitted Data 2007

19 Pancreatic cancer: EUS algorithm Patient with a pancreatic mass by CT/US or suspected pancreatic cancer with negative imaging studies No obvious metastatic disease Obvious metastatic disease (confirm by FNA) EUS staging and FNA No EUS evidence of advanced disease EUS evidence of advanced disease Surgical Neoadjuvant resection Rx and restaging? Palliative therapy (consider EUS guided celiac block)

20 Acute Pancreatitis Determination of Etiology Detection of choledocholithiasis by EUS in AP 100 consecutive pts. with AP Gallbladder stones: EUS more sensitive than US (100% vs. 84%, p<0.005) Choledocholithiasis: EUS ERCP (US) sensitivity 97% 97% (26%) specificity 98% 95% (100%) accuracy 98% 96% (75%) Liu, Gastrointest Endosc 2001

21 Changing trends in ERCP Advent of EUS ERCP diagnostic vs. therapeutic Jamal et al. Am J Gastroenterol 2007

22 Influence of biliary stents on EUS

23 Influence of biliary stents on EUS Overall concordance EUS/gold standard: 11/22 (50%) Surgical T stage T0 T1 T2 T3 T4 EUS T0 (n = 3) T0 (n = 1) T3 (n = 1) T0 (n = 2) T2 (n = 1) T4 (n = 1) T2 (n = 1) T3 (n = 2) T3 (n = 5) T4 (n = 5) % 100 (3/3) 0 (0/2) 25 (1/4) 67 (2/3) 50 (5/10) Fusaroli et al. Endoscopy 2007

24 Acute Pancreatitis: Determination of Etiology Does normal EUS obviate the need for ERCP? Prospective 1-year follow-up study in 238 pts. referred for biliary study with normal EUS [early (1-month) and late (1-year) follow-up details were obtained] 59 (25 %) pts. underwent cholecystectomy,, with (n=31) or without (n=28) IOC,, and 30 (13%) pts. underwent ERCP (13 %) CBD stone was found in 14 (6 %) patients NPV of EUS for CBD stones was 95.4 % Napoleon,, Endoscopy 2003

25 Acute Pancreatitis: Determination of Etiology Idiopathic AP Extensive and invasive evaluations (such as ERCP) are not needed after a single episode of Idiophatic AP. In patients in whom PCa is more likely (>40 yrs, smokers), an evaluation using MRCP, or EUS is preferably to using ERCP initially. Forsmark and Baillie. Gastroenterology 2007

26 EUS first vs. ERCP first for CBD Stones EUS group: 49 successful and 1 failed initial EUS, 15 ERCs for CBD stone tx,, and 6 procedures during f-upf ERC group: 36 successful and 12 failed initial ERCs,, 13 repeat procedures (EUS or ERC) and 2 during f-upf In intermediate probability CBD stones, EUS (with selective ERC in pts. with stones) is safer and not associated with an excess of endoscopic procedures compared with ERC alone Polkowski et al. Endoscopy 2007

27 EUS first vs. ERCP first in Biliary Acute Pancreatitis Occult cholelithiasis (missed by US) is best detected by EUS or MRCP. EUS sensitivity of 90%. Sludge in the gallbladder may form with prolonged fasting and may represent the consequence rather than the cause of pancreatitis. EUS is used to identify patients with biliary AP who have persistent CBD stones and thus select patients for ERCP. Forsmark and Baillie. Gastroenterology 2007

28 EUS first vs. ERCP first in Biliary Acute Pancreatitis In patients with mild or resolved biliary AP who are scheduled for cholecystectomy, in whom a preoperative question exists as to the presence of persistent CBD stones, preoperative EUS or MRCP is appropriate rather than proceeding directly to ERCP. Liu et al. Clin Gastroenterol Hepatol 2005

29 EUS first vs. ERCP first in Biliary Acute Pancreatitis Malignancy is a potential etiology (age>40 yrs). EUS could be used to screen not only for malignancy but also to assess for ampullary masses, pancreatic ductal dilatation, signs of chronic pancreatitis, and microlithiasis. Forsmark and Baillie. Gastroenterology 2007

30 EUS first vs. ERCP first in Biliary Acute Pancreatitis The most accurate method to identify cholelithiasis or coledocholithiasis in a patient with acute pancreatitis is endoscopic ultrasonography. Forsmark and Baillie. Gastroenterology 2007

31 Acute Pancreatitis:Management of Complications Pancreatic Infection: MRI and EUS provide the most reliable information to define the internal character of the collection and gauging its consistency. Pancreatic Fluid Collection and Pseudocyst: Endoscopic treatment, utilizing EUS guidance is becoming much more common. Forsmark and Baillie. Gastroenterology 2007

32 Changing trends in ERCP.Every ERCP should be performed for a solid indication: : it is not a game!.....with the avaliability of less- and non-invasive imaging techniques, such as EUS and MRCP, solely diagnostic ERCP is becoming a rarity...eus is increasingly important in both the diagnosis and staging of biliary and pancreatic cancer, and its therapeutic applications are increasing daily....eus and ERCP are complementary techniques. Baillie and Testoni. Gut 2007

33 Pancreatic Cysts Sahani et al. Radiographics 2005

34 Pancreatic Cysts Cooperative pancreatic cyst study Prospective study; 341 pts. CEA for all mucinous CPTs was significantly higher than CEA for all non-mucinous CPTs (cutoff 192 ng/ml) CA was the second best discriminating marker CONCLUSIONS: the determination of cyst fluid concentration of CEA alone is highly diagnostic and more accurate than any combination testing (p < ) Brugge et al. Gastroenterology 2004

35 Intra Papillary Mucinous Neoplasms: IPMN Callery, Gastroenterology 2006

36 Intra Papillary Mucinous Neoplasms: IPMN Callery, Gastroenterology 2006

37 PC arising in IPMN

38 Intra Papillary Mucinous Neoplasms: IPMN Pathological Diagnosis of Invasive IPMN Malignant cells & ductal structures infiltrating pancreatic parenchyma are required. Perineural, lymphatic,, and vascular invasion are variably seen with Invasive but never with nonivasive IPMN. Acellular pools of mucin alone are inadequate (non Invasive IPMN). Median overall survival is only 23 months for invasive IPMN, compared to 85 months for noninvasive disease. Raut et al. Ann Surg Oncol 2006

39 Intra Papillary Mucinous Neoplasms: IPMN Preoperative imaging, includig EUS Ca 19-9 levels Targeted EUS-FNA Could not reliably discriminate invasive and non invasive IPMN Only Jaundice is predictive of Invasive IPMN Raut et al. Ann Surg Oncol 2006

40 Intra Papillary Mucinous Neoplasms: IPMN- Conclusions A defensive approach is to remove them. But deciding to operate when observation is appropriate is wrong. In the old patients with comorbidity,, a misguided decision to resect can do more harm than good. We still need to learn more about the natural history of IPMN to become confortable with such decisions. Callery, Gastroenterology 2006

41 EUS in Pancreatic Cysts: Algorithm Cystic Lesion in the Pancreas Microcystic (SCA) EUS Other features Follow up High surgical risk Uncertain EUS Asymptomatic Low surgical risk Vegetation/Mass Wirsung dilated Symptomatic EUS-FNA Surgery

42 Avoidance of additional investigations Patients Additional investigations avoided Yes EUS-FNA 69 (30%) 45 (65 %) 33/44 (75%) Lung/mediastinal 10/21 (48%) Pancreaticobiliary 2/3 (67%) esophageal 0/1 gastric EUS without FNA 162 (70%) 70 (43%) 0/1 Lung/mediastinal 31/51 (61%) Pancreaticobiliary 23/72 (32%) esophageal 16/34 (47%) gastric p Value p < 0.08 Possible 5 (7.3%) 33 (20.4%) EUS usefulness No Very Moderately Minimally/ not useful 21 (30.4%) 45 (65.2%) 16 (23.2%) 8 (11.6) 62 (38.3%) 77 (47.5%) 72 (44.4%) 13 (8.1%) p < 0.8 Chong et al. Gastrointest Endosc 2005

43 Conclusions EUS results in a change of management in approximately one half of the patients. Staging with EUS is associated with a recurrence free survival advantage and an overall survival advantage. EUS is deemed useful by referring physicians. EUS is not only accurate but also cost- effective.

44 IV IEC / I EGEUS EUS COURSE Castel S. Pietro June

An Approach to Pancreatic Cysts. Introduction

An Approach to Pancreatic Cysts. Introduction An Approach to Pancreatic Cysts Nalini M. Guda, MD Aurora St. Luke s Medical Center, Milwaukee Clinical Adjunct Professor of Medicine, University of Wisconsin School of Medicine and Public Health Introduction

More information

The role of endoscopy in the diagnosis and treatment of cystic pancreatic neoplasms

The role of endoscopy in the diagnosis and treatment of cystic pancreatic neoplasms The role of endoscopy in the diagnosis and treatment of cystic pancreatic neoplasms CYSTIC LESIONS AND FLUID COLLECTIONS OF THE PANCREAS Their pathology ranges from pseudocysts and pancreatic necrosis

More information

ACG Clinical Guideline: Diagnosis and Management of Pancreatic Cysts

ACG Clinical Guideline: Diagnosis and Management of Pancreatic Cysts ACG Clinical Guideline: Diagnosis and Management of Pancreatic Cysts Grace H. Elta, MD, FACG 1, Brintha K. Enestvedt, MD, MBA 2, Bryan G. Sauer, MD, MSc, FACG (GRADE Methodologist) 3 and Anne Marie Lennon,

More information

Pancreatic Cystic Neoplasms: Guidelines and beyond

Pancreatic Cystic Neoplasms: Guidelines and beyond Pancreatic Cystic Neoplasms: Guidelines and beyond Kenneth J. Chang, MD, FACG, FASGE Executive Director, Comprehensive Digestive Disease Center Professor and Chief, Gastroenterology Vincent & Anna Kong

More information

Making ERCP Easy: Tips From A Master

Making ERCP Easy: Tips From A Master Making ERCP Easy: Tips From A Master Raj J. Shah, M.D., FASGE Associate Professor of Medicine University of Colorado School of Medicine Co-Director, Endoscopy Director, Pancreaticobiliary Endoscopy Services

More information

The Pancreas. Basic Anatomy. Endocrine pancreas. Exocrine pancreas. Pancreas vasculature. Islets of Langerhans. Acinar cells Ductal System

The Pancreas. Basic Anatomy. Endocrine pancreas. Exocrine pancreas. Pancreas vasculature. Islets of Langerhans. Acinar cells Ductal System SGNA: Back to Basics Rogelio G. Silva, MD Assistant Clinical Professor of Medicine University of Illinois at Chicago Department of Medicine Division of Gastroenterology Advocate Christ Medical Center GI

More information

Hepatobiliary and Pancreatic Malignancies

Hepatobiliary and Pancreatic Malignancies Hepatobiliary and Pancreatic Malignancies Gareth Eeson MD MSc FRCSC Surgical Oncologist and General Surgeon Kelowna General Hospital Interior Health Consultant, Surgical Oncology BC Cancer Agency Centre

More information

Dr Claire Smith, Consultant Radiologist St James University Hospital Leeds

Dr Claire Smith, Consultant Radiologist St James University Hospital Leeds Dr Claire Smith, Consultant Radiologist St James University Hospital Leeds Imaging in jaundice and 2ww pathway Image protocol Staging Limitations Pancreatic cancer 1.2.4 Refer people using a suspected

More information

ENDOSCOPY IN COMPETITION DIAGNOSTICS. Dr. med. Dirk Hartmann Klinikum Ludwigshafen

ENDOSCOPY IN COMPETITION DIAGNOSTICS. Dr. med. Dirk Hartmann Klinikum Ludwigshafen Falk Symposium 166 GI Endoscopy Standards and Innovations Mainz, 18. 19. September 2008 ENDOSCOPY IN COMPETITION DIAGNOSTICS Dr. med. Dirk Hartmann Klinikum Ludwigshafen ENDOSCOPY IN COMPETITION Competing

More information

Pancreatic Cysts. Darius C. Desai, MD FACS St. Luke s University Health Network

Pancreatic Cysts. Darius C. Desai, MD FACS St. Luke s University Health Network Pancreatic Cysts Darius C. Desai, MD FACS St. Luke s University Health Network None Disclosures Incidence Widespread use of cross sectional imaging Seen in over 2% of patients having abdominal imaging

More information

Outline. Intraductal Papillary Mucinous Neoplasm (IPMN) Guideline Review 4/6/2017. Case Example Background Classification Histology Guidelines

Outline. Intraductal Papillary Mucinous Neoplasm (IPMN) Guideline Review 4/6/2017. Case Example Background Classification Histology Guidelines Intraductal Papillary Mucinous Neoplasm (IPMN) Guideline Review The Nurse Practitioner Association New York State Capital Region Teaching Day Matthew Warndorf MD Case Example Background Classification

More information

Cystic Pancreatic Lesions: Approach to Diagnosis

Cystic Pancreatic Lesions: Approach to Diagnosis Cystic Pancreatic Lesions: Approach to Diagnosis Poster No.: R-0130 Congress: RANZCR-AOCR 2012 Type: Educational Exhibit Authors: A. AGARWAL, R. M. Mendelson; Perth/AU Keywords: Cysts, Biopsy, Endoscopy,

More information

What to do and not do before seeking surgical consultation for a patient with suspected pancreatic cancer

What to do and not do before seeking surgical consultation for a patient with suspected pancreatic cancer What to do and not do before seeking surgical consultation for a patient with suspected pancreatic cancer 9 Th Annual Symposium on Gastrointestinal Cancers, St. Louis University School of Medicine Carlos

More information

Endoscopic Management of Biliary Strictures. Sammy Ho, MD Director of Pancreaticobiliary Services and Endoscopic Ultrasound Montefiore Medical Center

Endoscopic Management of Biliary Strictures. Sammy Ho, MD Director of Pancreaticobiliary Services and Endoscopic Ultrasound Montefiore Medical Center Endoscopic Management of Biliary Strictures Sammy Ho, MD Director of Pancreaticobiliary Services and Endoscopic Ultrasound Montefiore Medical Center Malignant Biliary Strictures Etiologies: Pancreatic

More information

Matthew McCollough, M.D. April 9, 2009 University of Louisville

Matthew McCollough, M.D. April 9, 2009 University of Louisville Matthew McCollough, M.D. April 9, 2009 University of Louisville List the differential diagnosis for pancreatic cysts Review the epidemiology Illustrate the types of cysts through case discussions Discuss

More information

A LEADER IN ADVANCED ENDOSCOPY AND HEPATOBILIARY SURGERY

A LEADER IN ADVANCED ENDOSCOPY AND HEPATOBILIARY SURGERY A LEADER IN ADVANCED ENDOSCOPY AND HEPATOBILIARY SURGERY St. Peter s Hospital Advanced Endoscopy & Hepatobiliary Center Welcome The St. Peter s Hospital Advanced Endoscopy & Hepatobiliary Center is a leader

More information

The Role of Molecular Analysis in the Diagnosis and Surveillance of Pancreatic Cystic Neoplasms

The Role of Molecular Analysis in the Diagnosis and Surveillance of Pancreatic Cystic Neoplasms JOP. J Pancreas (Online) 20 Mar 20; (2):-9. RESEARCH ARTICLE The Role of Molecular Analysis in the Diagnosis and Surveillance of Pancreatic Cystic Neoplasms Megan Winner, Amrita Sethi 2, John M Poneros

More information

The campaign on laboratory: focus on Gallstone Disease and ERCP

The campaign on laboratory: focus on Gallstone Disease and ERCP The campaign on laboratory: focus on Gallstone Disease and ERCP Mauro Giuliani, MD, Specialist in Visceral Surgery, Vice Head Physician, Surgical Ward, Ospedale Regionale di Locarno Alberto Fasoli, MD,

More information

CHOLANGIOCARCINOMA (CCA)

CHOLANGIOCARCINOMA (CCA) CHOLANGIOCARCINOMA (CCA) Deepak Hariharan MD (Research), FRCS, Locum Consultant HPB Surgeon AIM Outline essential facts & principles Present 4 cases Discuss Challenges /Controversies INTRODUCTION Most

More information

Suspicious Cytologic Diagnostic Category in Endoscopic Ultrasound-Guided FNA of the Pancreas: Follow-Up and Outcomes

Suspicious Cytologic Diagnostic Category in Endoscopic Ultrasound-Guided FNA of the Pancreas: Follow-Up and Outcomes Suspicious Cytologic Diagnostic Category in Endoscopic Ultrasound-Guided FNA of the Pancreas: Follow-Up and Outcomes Evan A. Alston, MD 1 ; Sejong Bae, PhD 2 ; and Isam A. Eltoum, MD, MBA 1 BACKGROUND:

More information

Biliary tree dilation - and now what?

Biliary tree dilation - and now what? Biliary tree dilation - and now what? Poster No.: C-1767 Congress: ECR 2012 Type: Educational Exhibit Authors: I. Ferreira, A. B. Ramos, S. Magalhães, M. Certo; Porto/PT Keywords: Pathology, Diagnostic

More information

The Use of Pancreatoscopy in the Diagnosis of Intraductal Papillary Mucinous Tumor Lesions of the Pancreas

The Use of Pancreatoscopy in the Diagnosis of Intraductal Papillary Mucinous Tumor Lesions of the Pancreas CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2005;3:S53 S57 The Use of Pancreatoscopy in the Diagnosis of Intraductal Papillary Mucinous Tumor Lesions of the Pancreas KENJIRO YASUDA, MUNEHIRO SAKATA, MOOSE

More information

Evaluation of AGA and Fukuoka Guidelines for EUS and surgical resection of incidental pancreatic cysts

Evaluation of AGA and Fukuoka Guidelines for EUS and surgical resection of incidental pancreatic cysts Evaluation of AGA and Fukuoka Guidelines for EUS and surgical resection of incidental pancreatic cysts Authors Alexander Lee 1, Vivek Kadiyala 2,LindaS.Lee 3 Institutions 1 Texas Digestive Disease Consultants,

More information

7/11/2017. We re gonna help a lot of people today. Biliary/Pancreatic Endoscopy. AGS July 1-2, Kenneth M. Sigman, MD

7/11/2017. We re gonna help a lot of people today. Biliary/Pancreatic Endoscopy. AGS July 1-2, Kenneth M. Sigman, MD Biliary/Pancreatic Endoscopy AGS July 1-2, 2017 Kenneth M. Sigman, MD We re gonna help a lot of people today 1 2 3 4 Cannulation It all starts with cannulation Double Wire Cannulation Difficult cannulations

More information

Frank Burton Memorial Update on Pancreato-biliary Cancers

Frank Burton Memorial Update on Pancreato-biliary Cancers Frank Burton Memorial Update on Pancreato-biliary Cancers Diagnosis and management of pancreatic cancer: common dilemmas Moderators: Banke Agarwal, MD Paul Buse, MD Evaluation of patients with obstructive

More information

Evaluation and Management of Refractory Biliary Stricture. J. David Horwhat, MD, FACG Director of Endoscopy Lancaster Gastroenterology, Inc.

Evaluation and Management of Refractory Biliary Stricture. J. David Horwhat, MD, FACG Director of Endoscopy Lancaster Gastroenterology, Inc. Evaluation and Management of Refractory Biliary Stricture J. David Horwhat, MD, FACG Director of Endoscopy Lancaster Gastroenterology, Inc Outline What defines a refractory biliary stricture Endoscopic

More information

Intraductal papillary neoplasms in the bile ducts

Intraductal papillary neoplasms in the bile ducts Intraductal papillary neoplasms in the bile ducts Seok Hwa Youn Myunghee Yoon Dong Hoon Shin Kosin University Gospel Hospital Department of general surgery Hepato-biliary-pancreatic division Introduction

More information

X-ray Corner. Imaging of The Pancreas. Pantongrag-Brown L

X-ray Corner. Imaging of The Pancreas. Pantongrag-Brown L X-ray Corner 125 Imaging of The Pancreas Modern imaging modalities commonly used in pancreas include ultrasound (US), CT, and MRI. Pancreas is a retroperitoneal organ which makes it difficult to visualize

More information

PANCREATIC PSEUDOCYSTS: Optimal therapeutic strategies. Jacques DEVIERE, MD, PhD Erasme University Hospital Brussels

PANCREATIC PSEUDOCYSTS: Optimal therapeutic strategies. Jacques DEVIERE, MD, PhD Erasme University Hospital Brussels PANCREATIC PSEUDOCYSTS: Optimal therapeutic strategies Jacques DEVIERE, MD, PhD Erasme University Hospital Brussels 1. Diagnosis. 2. Multidisciplinary approach. 3. Therapeutic planning. 4. How? 5. Follow-up

More information

Management A Guideline Based Approach to the Incidental Pancreatic Cysts. Common Cystic Pancreatic Neoplasms.

Management A Guideline Based Approach to the Incidental Pancreatic Cysts. Common Cystic Pancreatic Neoplasms. Management 2016 A Guideline Based Approach to the Incidental Pancreatic Cysts ISMRM 2016 Masoom Haider, MD, FRCP(C) Professor of Radiology, University of Toronto Clinician Scientist, Ontario Institute

More information

Types of IPMN. Pancreas Cysts: An Incidental Finding or Harbinger of Malignancy. Cysts: Early Neoplasia. Mucinous Cystic Lesions. EUS-guided FNA EUS

Types of IPMN. Pancreas Cysts: An Incidental Finding or Harbinger of Malignancy. Cysts: Early Neoplasia. Mucinous Cystic Lesions. EUS-guided FNA EUS Pancreas Cysts: An Incidental Finding or Harbinger of Malignancy EUS-guided FNA William R. Brugge,, MD, FACG Professor of Medicine Harvard Medical School Director, GI Endoscopy Unit Massachusetts General

More information

Diagnostic performance of endoscopic ultrasound-guided fine-needle aspiration in pancreatic lesions

Diagnostic performance of endoscopic ultrasound-guided fine-needle aspiration in pancreatic lesions European Review for Medical and Pharmacological Sciences 2018; 22: 1397-1401 Diagnostic performance of endoscopic in pancreatic lesions Q.-M. WU 1, Y.-N. GUO 1, Y.-Q. XU 1 Digestive Department of Beijing

More information

Figure 2: Post-cholecystectomy biliary-like pain

Figure 2: Post-cholecystectomy biliary-like pain Figure 2: Post-cholecystectomy biliary-like pain 1 patient with recurrent episodes of pain (not daily), in the epigastrium/right upper quadrant, lasting >30 mins, building to a steady level, interrupting

More information

Pictorial review of Benign Biliary tract abnormality on MRCP/MRI Liver with Endoscopic (including splyglass) and Endoscopic Ultrasound correlation

Pictorial review of Benign Biliary tract abnormality on MRCP/MRI Liver with Endoscopic (including splyglass) and Endoscopic Ultrasound correlation Pictorial review of Benign Biliary tract abnormality on MRCP/MRI Liver with Endoscopic (including splyglass) and Endoscopic Ultrasound correlation Poster No.: C-2617 Congress: ECR 2015 Type: Educational

More information

Endoscopic management of postoperative bile duct injuries: a single center experience.

Endoscopic management of postoperative bile duct injuries: a single center experience. 1- Endoscopic management of postoperative bile duct injuries: a single center experience. BACKGROUND/AIM: Biliary endoscopic procedures may be less invasive than surgery for management of postoperative

More information

Esophageal seeding after endoscopic ultrasound-guided fine-needle aspiration of a mediastinal tumor

Esophageal seeding after endoscopic ultrasound-guided fine-needle aspiration of a mediastinal tumor Esophageal seeding after endoscopic ultrasound-guided fine-needle aspiration of a mediastinal tumor Authors Kensuke Yokoyama 1,JunUshio 1,NorikatsuNumao 1, Kiichi Tamada 1, Noriyoshi Fukushima 2, Alan

More information

Subepithelial Lesions of the Gut: When Should I Worry?

Subepithelial Lesions of the Gut: When Should I Worry? Subepithelial Lesions of the Gut: When Should I Worry? President, ASGE Chairman, GI & Hepatology Scottsdale, AZ Faigel.douglas@mayo.edu Case 55 yo male with reflux EGD for Barrett s Screening SET, mucosal

More information

3/28/2012. Periampullary Tumors. Postgraduate Course in General Surgery CASE 1: CASE 1: Overview. Eric K. Nakakura Ko Olina, HI

3/28/2012. Periampullary Tumors. Postgraduate Course in General Surgery CASE 1: CASE 1: Overview. Eric K. Nakakura Ko Olina, HI Overview Postgraduate Course in General Surgery Case presentation Differential diagnosis Diagnosis and therapy Outcomes Principles of palliative care Eric K. Nakakura Ko Olina, HI March 27, 2012 CASE 1:

More information

Esophageal cancer: Biology, natural history, staging and therapeutic options

Esophageal cancer: Biology, natural history, staging and therapeutic options EGEUS 2nd Meeting Esophageal cancer: Biology, natural history, staging and therapeutic options Michael Bau Mortensen MD, Ph.D. Associate Professor of Surgery Centre for Surgical Ultrasound, Upper GI Section,

More information

Endoscopic ultrasonography in suspected pancreatic malignancy and indecisive CT

Endoscopic ultrasonography in suspected pancreatic malignancy and indecisive CT O r i g i n a l a r t i c l e Endoscopic ultrasonography in suspected pancreatic malignancy and indecisive CT O.L.M. Meijer 1, R.K. Weersma 1, E.J. van der Jagt 2, H.M. van Dullemen 1 * Departments of

More information

PersPeCTIves. Controversies in the management of pancreatic ipmn. Masao Tanaka

PersPeCTIves. Controversies in the management of pancreatic ipmn. Masao Tanaka PersPeCTIves OpiniOn Controversies in the management of pancreatic ipmn Masao Tanaka Abstract Although considerable progress has been made in our understanding of intraductal papillary mucinous neoplasm

More information

Sphincter of Oddi Dysfunction Type III, Manometry and Sphincterotomy: Sham Won, Game Over

Sphincter of Oddi Dysfunction Type III, Manometry and Sphincterotomy: Sham Won, Game Over Sphincter of Oddi Dysfunction Type III, Manometry and Sphincterotomy: Sham Won, Game Over C. Mel Wilcox, M.D., M.S.P.H. Professor of Medicine, Surgery and Pediatrics University of Alabama, Birmingham Basil

More information

Intraductal papillary mucinous neoplasm (IPMN) is a distinct

Intraductal papillary mucinous neoplasm (IPMN) is a distinct CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2008;6:815 819 Evaluation of the Guidelines for Management of Pancreatic Branch-Duct Intraductal Papillary Mucinous Neoplasm RAYMOND S. TANG,* BENJAMIN WEINBERG,

More information

Surgical management and results for cystic neoplasms of pancreas

Surgical management and results for cystic neoplasms of pancreas Korean J Hepatobiliary Pancreat Surg 2013;17:118-125 Original Article Surgical management and results for cystic neoplasms of pancreas Kyung Won Han 1, Ryun Ha 1, Kun Kuk Kim 1, Jung Nam Lee 1, Yeon Suk

More information

Evidence based imaging of the pancreas

Evidence based imaging of the pancreas Evidence based imaging of the pancreas D.Vanbeckevoort, D.Bielen, K.Op de beeck, R.Vanslembrouck Department of Radiology Chairman Prof. Dr. R.Oyen Non-invasive imaging tests available for the diagnosis

More information

Imaging techniques in the diagnosis, staging and follow up of GI cancers. Moderators: Banke Agarwal, MD and Paul Schultz, MD

Imaging techniques in the diagnosis, staging and follow up of GI cancers. Moderators: Banke Agarwal, MD and Paul Schultz, MD Imaging techniques in the diagnosis, staging and follow up of GI cancers Moderators: Banke Agarwal, MD and Paul Schultz, MD Panelists Axel Grothey, MD Professor of Oncology Division of Medical Oncology

More information

Intraductal Papillary Mucinous Neoplasms: We Still Have a Way to Go! Francesco M. Serafini, MD, FACS

Intraductal Papillary Mucinous Neoplasms: We Still Have a Way to Go! Francesco M. Serafini, MD, FACS Intraductal Papillary Mucinous Neoplasms: We Still Have a Way to Go! Francesco M. Serafini, MD, FACS Brooklyn VAMC September 21 st GI Grand Rounds - What is it? - Clinical entity that has emerged from

More information

5/17/2013. Pancreatic Cancer. Postgraduate Course in General Surgery CASE 1: CASE 1: Overview. Case presentation. Differential diagnosis

5/17/2013. Pancreatic Cancer. Postgraduate Course in General Surgery CASE 1: CASE 1: Overview. Case presentation. Differential diagnosis Overview Case presentation Postgraduate Course in General Surgery Differential diagnosis Diagnosis and therapy Eric K. Nakakura Koloa, HI March 26, 2013 Outcomes CASE 1: CASE 1: A 78-year-old man developed

More information

Evaluation of Suspected Pancreatic Cancer

Evaluation of Suspected Pancreatic Cancer Evaluation of Suspected Pancreatic Cancer October 15, 2015 If you experience technical difficulty during the presentation: Contact WebEx Technical Support directly at: US Toll Free: 1-866-779-3239 Toll

More information

Introduction of Endoscopic Ultrasonography (EUS)

Introduction of Endoscopic Ultrasonography (EUS) Introduction of Endoscopic Ultrasonography (EUS) Dr. Yuk Tong LEE MBChB, MD(CUHK), FRCP (Edin), FRCP(Lond), FHKCP, FHKAM Specialist in Gastroenterology and Hepatology Endoscopic Ultrasonography (EUS) ª

More information

Upper GI Malignancies Imaging Guidelines for the Management of Gastric, Oesophageal & Pancreatic Cancers 2012

Upper GI Malignancies Imaging Guidelines for the Management of Gastric, Oesophageal & Pancreatic Cancers 2012 Upper GI Malignancies Imaging Guidelines for the Management of Gastric, Oesophageal & Pancreatic Cancers 2012 Version Control This is a controlled document please destroy all previous versions on receipt

More information

Original article. Introduction!

Original article. Introduction! 382 Original article Peritoneal seeding in intraductal papillary mucinous neoplasm of the pancreas patients who underwent endoscopic ultrasound-guided fine-needle aspiration: The PIPE Study Authors Won

More information

ERCP and EUS: What s New and What Should We Do?

ERCP and EUS: What s New and What Should We Do? ERCP and EUS: What s New and What Should We Do? Rajesh N. Keswani, MD Associate Professor of Medicine Division of Gastroenterology Northwestern University Feinberg School of Medicine EUS/ERCP in 2015 THE

More information

Disclosures. Extra-hepatic Biliary Disease and the Pancreas. Objectives. Pancreatitis 10/3/2018. No relevant financial disclosures to report

Disclosures. Extra-hepatic Biliary Disease and the Pancreas. Objectives. Pancreatitis 10/3/2018. No relevant financial disclosures to report Extra-hepatic Biliary Disease and the Pancreas Disclosures No relevant financial disclosures to report Jeffrey Coughenour MD FACS Clinical Associate Professor of Surgery and Emergency Medicine Division

More information

Presence of choledocholithiasis in patients undergoing cholecystectomy for mild biliary pancreatitis

Presence of choledocholithiasis in patients undergoing cholecystectomy for mild biliary pancreatitis Original Article Presence of choledocholithiasis in patients undergoing cholecystectomy for mild biliary pancreatitis Pradhan S 1, Shah S 2, Maharjan S 2, Shah JN 3 1 2 2 3 Professor, Patan hospital Correspondence:

More information

Diagnosis and Management of Primary Sclerosing Cholangitis:

Diagnosis and Management of Primary Sclerosing Cholangitis: Diagnosis and Management of Primary Sclerosing Cholangitis: The Role of the Endoscopist Adam Slivka MD-PhD Associate Chief of the Division Gastroenterology Hepatology and Nutrition University of Pittsburgh

More information

ROSE in EUS guided FNA of Pancreatic Lesions

ROSE in EUS guided FNA of Pancreatic Lesions ROSE in EUS guided FNA of Pancreatic Lesions Guy s Hospital, London, 16 April 2018 Laxmi Batav Imperial College NHS Trust Imperial College NHS Trust Cytology Workload Cervical Cytology 57,500 (decreases

More information

CASE REPORT. Abstract. Introduction. Case Report

CASE REPORT. Abstract. Introduction. Case Report CASE REPORT Branch Duct Intraductal Papillary Mucinous Neoplasms of the Pancreas Involving Type 1 Localized Autoimmune Pancreatitis with Normal Serum IgG4 Levels Successfully Diagnosed by Endoscopic Ultrasound-guided

More information

Case 1- B.N. 66 yr old F with PMHx of breast cancer s/ p mastectomy, HTN, DM presented with dysphagia to solids and liquids.

Case 1- B.N. 66 yr old F with PMHx of breast cancer s/ p mastectomy, HTN, DM presented with dysphagia to solids and liquids. Case 1- B.N 66 yr old F with PMHx of breast cancer s/ p mastectomy, HTN, DM presented with dysphagia to solids and liquids. Reports retching to clear esophagus. Case 1- B.N EGD: Stricture in the distal

More information

Evaluation and Management of Cystic Lesions of the Pancreas: When to Resect, When to Follow and When to Forget

Evaluation and Management of Cystic Lesions of the Pancreas: When to Resect, When to Follow and When to Forget Evaluation and Management of Cystic Lesions of the Pancreas: When to Resect, When to Follow and When to Forget Randall Brand, MD Professor of Medicine Division of Gastroenterology, Hepatology and Nutrition

More information

ACG Clinical Guideline: Management of Acute Pancreatitis

ACG Clinical Guideline: Management of Acute Pancreatitis ACG Clinical Guideline: Management of Acute Pancreatitis Scott Tenner, MD, MPH, FACG 1, John Baillie, MB, ChB, FRCP, FACG 2, John DeWitt, MD, FACG 3 and Santhi Swaroop Vege, MD, FACG 4 1 State University

More information

Pancreatico-biliary cytology: a practical approach to diagnosis. Corina Cotoi

Pancreatico-biliary cytology: a practical approach to diagnosis. Corina Cotoi Pancreatico-biliary cytology: a practical approach to diagnosis Corina Cotoi Pancreatico-biliary lesions Solid: Ductal adenocarcinoma Cholangiocarcinoma Acinar cell carcinoma Neuroendocrine tumour / carcinoma

More information

Endoscopic Ultrasound Guided Trucut Biopsy of the Cyst Wall for Diagnosing Cystic Pancreatic Tumors

Endoscopic Ultrasound Guided Trucut Biopsy of the Cyst Wall for Diagnosing Cystic Pancreatic Tumors CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2005;3:974 979 Endoscopic Ultrasound Guided Trucut Biopsy of the Cyst Wall for Diagnosing Cystic Pancreatic Tumors MICHAEL J. LEVY,* THOMAS C. SMYRK, RAGHURAM P.

More information

Acute Pancreatitis. Case: NG. Idiopathic Pancreatitis is Common. Investigation and Management of Idiopathic Acute Recurrent Pancreatitis (IARP)

Acute Pancreatitis. Case: NG. Idiopathic Pancreatitis is Common. Investigation and Management of Idiopathic Acute Recurrent Pancreatitis (IARP) BRIGHAM AND WOMENS HOSPITAL Investigation and Management of (IARP) Acute Pancreatitis j Darwin L. Conwell MD, MS Associate Professor of Medicine Harvard Medical School Boston, MA Case: NG 54 year old female

More information

The role of ERCP in chronic pancreatitis

The role of ERCP in chronic pancreatitis The role of ERCP in chronic pancreatitis Marianna Arvanitakis Erasme University Hospital, ULB, Brussels, Belgium 10 th Nottingham Endoscopy Masterclass SPEAKER DECLARATIONS This presenter has the following

More information

Chronic pancreatitis mimicking intraductal papillary mucinous neoplasm of the pancreas; Report of tow cases

Chronic pancreatitis mimicking intraductal papillary mucinous neoplasm of the pancreas; Report of tow cases Jichi Medical University Journal Chronic pancreatitis mimicking intraductal papillary mucinous neoplasm of the pancreas; Report of tow cases Noritoshi Mizuta, Hiroshi Noda, Nao Kakizawa, Nobuyuki Toyama,

More information

Case Scenario 1. Discharge Summary

Case Scenario 1. Discharge Summary Case Scenario 1 Discharge Summary A 69-year-old woman was on vacation and noted that she was becoming jaundiced. Two months prior to leaving on that trip, she had had a workup that included an abdominal

More information

THE AMERICAN JOURNAL OF GASTROENTEROLOGY Vol. 96, No. 10, by Am. Coll. of Gastroenterology ISSN /01/$20.00

THE AMERICAN JOURNAL OF GASTROENTEROLOGY Vol. 96, No. 10, by Am. Coll. of Gastroenterology ISSN /01/$20.00 THE AMERICAN JOURNAL OF GASTROENTEROLOGY Vol. 96, No. 10, 2001 2001 by Am. Coll. of Gastroenterology ISSN 0002-9270/01/$20.00 Published by Elsevier Science Inc. PII S0002-9270(01)02807-6 Can Endoscopic

More information

40th European Congress of Cytology Liverpool, UK, 2-5 th October 2016

40th European Congress of Cytology Liverpool, UK, 2-5 th October 2016 40th European Congress of Cytology Liverpool, UK, 2-5 th October 2016 EUS FNA of abdominal organs: An approach to reporting and triage for ancillary testing Date and time: Sunday 2 nd October 2016 15.00-16.30

More information

Endoscopic Ultrasound in Patients Over 80 Years Old

Endoscopic Ultrasound in Patients Over 80 Years Old DOI 10.1007/s10620-011-1718-7 ORIGINAL ARTICLE Endoscopic Ultrasound in Patients Over 80 Years Old Tan Attila Douglas O. Faigel Received: 11 January 2011 / Accepted: 8 April 2011 Ó Springer Science+Business

More information

Intended for use by Clinicians and Health Care Providers involved in the Management or Referral of adult patients with pancreatic

Intended for use by Clinicians and Health Care Providers involved in the Management or Referral of adult patients with pancreatic Intended for use by Clinicians and Health Care Providers involved in the Management or Referral of adult patients with pancreatic cancer Section AA Cancer Centre Referrals In the absence of metastatic

More information

PANCREATIC PSEUDOCYSTS. Madhuri Rao MD PGY-5 Kings County Hospital Center

PANCREATIC PSEUDOCYSTS. Madhuri Rao MD PGY-5 Kings County Hospital Center PANCREATIC PSEUDOCYSTS Madhuri Rao MD PGY-5 Kings County Hospital Center 34 yo M Case Presentation PMH: Chronic pancreatitis (ETOH related) PSH: Nil Meds: Nil NKDA www.downstatesurgery.org Symptoms o Chronic

More information

Biliary MRI w Eovist

Biliary MRI w Eovist Biliary MRI w Eovist Is there any added value? Elmar M. Merkle, MD Director of MR Imaging Duke University Medical Center elmar.merkle@duke.edu Declaration of Conflict of Interest or Relationship Research

More information

Pancreatic Adenocarcinoma

Pancreatic Adenocarcinoma Pancreatic Adenocarcinoma AProf Lara Lipton 28 April 2018 Percentage alive 5 years after diagnosis for men and women Epidemiology 6% of cancer related deaths worldwide 4 th highest cause of cancer death

More information

ENDOSCOPIC ULTRASOUND

ENDOSCOPIC ULTRASOUND ENDOSCOPIC ULTRASOUND Furqaan Ahmed Aga Khan University Hospital, Karachi, Pakistan. REVIEW ARTICLE : 13-20 Conventional endoscopy has allowed examination and sampling of the mucosal layer of the gastrointestinal

More information

Introduction of GB polyp

Introduction of GB polyp Management of Gallbladder Polyp as Physician's View Sang Hyub Lee, MD, PhD Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Internal Medicine Division

More information

Patient History. A 58 year old man presents with a 16 mm cyst in the pancreatic tail. The cyst is unilocular with a thick wall and no mural nodule.

Patient History. A 58 year old man presents with a 16 mm cyst in the pancreatic tail. The cyst is unilocular with a thick wall and no mural nodule. Case 1 Martha Bishop Pitman, MD Director of Cytopathology Massachusetts General Hospital Associate Professor of Pathology Harvard Medical School Boston, MA Patient History A 58 year old man presents with

More information

Nonsurgical Management of Asymptomatic Incidental Pancreatic Cysts

Nonsurgical Management of Asymptomatic Incidental Pancreatic Cysts CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2007;5:813 817 Nonsurgical Management of Asymptomatic Incidental Pancreatic Cysts MAOR LAHAV, YAKOV MAOR, BENJAMIN AVIDAN, BEN NOVIS, and SIMON BAR MEIR Department

More information

Cystic pancreatic lesions A proposal for a network approach. Chris Briggs Consultant HPB Surgeon Peninsula HPB Unit Derriford Hospital, Plymouth

Cystic pancreatic lesions A proposal for a network approach. Chris Briggs Consultant HPB Surgeon Peninsula HPB Unit Derriford Hospital, Plymouth Cystic pancreatic lesions A proposal for a network approach Chris Briggs Consultant HPB Surgeon Peninsula HPB Unit Derriford Hospital, Plymouth Aims Brief overview of cystic pancreatic lesions International

More information

Surgical Management of Pancreatic Cancer

Surgical Management of Pancreatic Cancer I Congresso de Oncologia D Or July 5-6, 2013 Surgical Management of Pancreatic Cancer Michael A. Choti, MD, MBA, FACS Department of Surgery Johns Hopkins University School of Medicine, Baltimore, MD Estimated

More information

Kenneth D. Chi, MD Medical Director GI Lab Advocate Lutheran General Hospital

Kenneth D. Chi, MD Medical Director GI Lab Advocate Lutheran General Hospital Kenneth D. Chi, MD Medical Director GI Lab Advocate Lutheran General Hospital Advances in Digestive Health for the Primary Care Physician Symposium May 2, 2015 None Case Presentation Types of Pancreatic

More information

Original Policy Date 12:2013

Original Policy Date 12:2013 MP 6.01.30 Magnetic Resonance Cholangiopancreatography Medical Policy Section Radiology Is12:2013sue 3:2005 Original Policy Date 12:2013 Last Review Status/Date 12:2013 Return to Medical Policy Index Disclaimer

More information

Original Article. Rattanasupar A Attasaranya S Ovartlarnporn B ABSTRACT

Original Article. Rattanasupar A Attasaranya S Ovartlarnporn B ABSTRACT 74 THAI J GASTROENTEROL 2010 Esophagogastroduodenoscopy (EGD) plus Transabdominal Ultrasound (TUS) for Diagnosed Dyspepsia in Elderly Patients Original Article Esophagogastroduodenoscopy (EGD) plus Transabdominal

More information

Cystic lesions of the pancreas

Cystic lesions of the pancreas REVIEW ARTICLE Annals of Gastroenterology (2016) 29, 155-161 Cystic lesions of the pancreas Ioannis Karoumpalis a, Dimitrios K. Christodoulou b General Hospital of Athens G. Gennimatas, Athens; University

More information

Management of Pancreatic Fistulae

Management of Pancreatic Fistulae Management of Pancreatic Fistulae Jose Ramos University of the Witwatersrand Donald Gordon Medical Centre Fistula definition A Fistula is a permanent abnormal passageway between two organs (epithelial

More information

Case Report (1) Sphincter of Oddi Dysfunction. Case Report (3) Case Report (2) Case Report (4) Case Report (5)

Case Report (1) Sphincter of Oddi Dysfunction. Case Report (3) Case Report (2) Case Report (4) Case Report (5) Dr David Westaby Imperial NHS Trust Imperial College Medical School London Case Report (1)! TD 33yr old male! Feb May 2010: Recurrent episodes of abdominal pain! June 2010 Episode severe abdominal pain

More information

Approach hto Indeterminate Biliary Strictures

Approach hto Indeterminate Biliary Strictures Approach hto Indeterminate t Biliary Strictures Andrew Y. Wang, MD, FACG, FASGE Associate Professor of Medicine Co-Medical Director of Endoscopy Director of Pancreatico-Biliary Services Division of Gastroenterology

More information

Endoscopic Ultrasonography Assessment for Ampullary and Bile Duct Malignancy

Endoscopic Ultrasonography Assessment for Ampullary and Bile Duct Malignancy Diagnostic and Therapeutic Endoscopy, Vol. 3, pp. 35-40 Reprints available directly from the publisher Photocopying permitted by license only (C) 1996 OPA (Overseas Publishers Association) Amsterdam B.V.

More information

Genetics of Pancreatic Cancer. October 6, If you experience technical difficulty during the presentation:

Genetics of Pancreatic Cancer. October 6, If you experience technical difficulty during the presentation: Genetics of Pancreatic Cancer October 6, 2016 If you experience technical difficulty during the presentation: Contact WebEx Technical Support directly at: US Toll Free: 1-866-229-3239 Toll Only: 1-408-435-7088

More information

Select problems in cystic pancreatic lesions

Select problems in cystic pancreatic lesions Disclosure Select problems in cystic pancreatic lesions Five Prime Therapeutics shareholder Adicet Bio shareholder Bristol-Meyer Squibb advisory board grace.kim@ucsf.edu Pancreatic cystic lesions Intraductal

More information

Therapeutic EUS: today & tomorrow Pietro Fusaroli

Therapeutic EUS: today & tomorrow Pietro Fusaroli Therapeutic EUS: today & tomorrow Pietro Fusaroli Gastroenterologia Università di Bologna AUSL di Imola, Castel S. Pietro Terme (BO) Direttore Prof. G. Caletti EUS FNA: CONVEX ARRAY Olympus, Pentax, Toshiba

More information

Pancreas Case Scenario #1

Pancreas Case Scenario #1 Pancreas Case Scenario #1 An 85 year old white female presented to her primary care physician with increasing abdominal pain. On 8/19 she had a CT scan of the abdomen and pelvis. This showed a 4.6 cm mass

More information

A patient with an unusual congenital anomaly of the pancreaticobiliary tree

A patient with an unusual congenital anomaly of the pancreaticobiliary tree A patient with an unusual congenital anomaly of the pancreaticobiliary tree Thomas Hocker, HMS IV BIDMC Core Radiology Case Presentation September 17, 2007 Review of Normal Pancreaticobiliary Tract Anatomy

More information

EUS in the Management of

EUS in the Management of EUS in the Management of Pancreaticobiliary Cancers Frank Gress, MD Professor of Medicine and Chief Division of Gastroenterology and Hepatology State University of New York Downstate Medical Center Brooklyn,

More information

Cystic Lesions of the Pancreas: Changes in the Presentation and Management of 1,424 Patients at a Single Institution over a 15-Year Time Period

Cystic Lesions of the Pancreas: Changes in the Presentation and Management of 1,424 Patients at a Single Institution over a 15-Year Time Period Cystic Lesions of the Pancreas: Changes in the Presentation and Management of 1,424 Patients at a Single Institution over a 15-Year Time Period Sébastien Gaujoux, MD, PhD, Murray F Brennan, MD, FACS, Mithat

More information

Outline 11/2/2017. Pancreatic EUS-FNA general aspects. Cytomorphologic features of solid neoplasms/lesions of the pancreas

Outline 11/2/2017. Pancreatic EUS-FNA general aspects. Cytomorphologic features of solid neoplasms/lesions of the pancreas ENDOSCOPIC ULTRASOUND GUIDED-FINE NEEDLE ASPIRATION CYTOLOGY OF PANCREAS Khalid Amin M.D. Assistant Professor Department of Laboratory Medicine and Pathology University of Minnesota Outline Pancreatic

More information

Neoplasias Quisticas del Páncreas

Neoplasias Quisticas del Páncreas SEAP -Aproximación Práctica a la Patología Gastrointestinal- Madrid, 26 de mayo, 2006 Neoplasias Quisticas del Páncreas Gregory Y. Lauwers, M.D. Director, Service Massachusetts General Hospital Harvard

More information

Evidence-based guidelines for diagnosis of common bile duct stones Vanja Giljaca University Hospital Center Rijeka Department of Gastroenterology

Evidence-based guidelines for diagnosis of common bile duct stones Vanja Giljaca University Hospital Center Rijeka Department of Gastroenterology Evidencebased guidelines for diagnosis of common bile duct stones Vanja Giljaca University Hospital Center Rijeka Department of Gastroenterology Trusted evidence. Informed decisions. Better health. Outline

More information

WallFlex Stents Technique Spotlights

WallFlex Stents Technique Spotlights WallFlex Stents Technique Spotlights OPEN TO THE POSSIBILITIES SEAN E. McGarr, do Kennebec Gastrointestinal Associates Maine General Medical Center, Augusta, ME 04330, United States Director of Gastrointestinal

More information

Sex-related differences in predicting choledocholithiasis using current American Society of Gastrointestinal Endoscopy risk criteria

Sex-related differences in predicting choledocholithiasis using current American Society of Gastrointestinal Endoscopy risk criteria ORIGINAL ARTICLE Annals of Gastroenterology (2018) 31, 1-6 Sex-related differences in predicting choledocholithiasis using current American Society of Gastrointestinal Endoscopy risk criteria Ankit Chhoda

More information