Some authors have suggested that intraductal papillary mucinous neoplasms of the bile duct(IPMN-B) could be the the biliary counterpart of IPMN of the pancreas(IPMN-P) since they share several clinical-pathological fe...Some authors have suggested that intraductal papillary mucinous neoplasms of the bile duct(IPMN-B) could be the the biliary counterpart of IPMN of the pancreas(IPMN-P) since they share several clinical-pathological features.These include prominent intraductal papil-lary proliferation pattern,a gastrointestinal phenotype,frequent mucin hyper-secretion and progression to mu-cinous carcinoma.To date there are just four reported cases of patients with synchronous IPMN-B and IPMN-P all of which were treated surgically.We hereby report the case of a 76-year-old woman who was incidentally diagnosed with both an asymptomatic 3 cm bulky uid lesion obstructing the bile duct lumen,diagnosed as a malignant IPMN-B,and synchronous multiple pancreatic cystic lesions(10-13 mm) communicating with an irreg-ular Wirsung,diagnosed as branch duct IPMN-P.Since surgery was ruled-out because of the patient's age and preferences,she underwent a conservative manage-ment regimen comprising both chemotherapy and radio-therapy.This was effective in decreasing the mass size and in resolving subsequent jaundice.This is also the f irst reported case of IPMN-B successfully treated with chemoradiotherapy.Clinicians should consider medical treatment as an option in this clinical scenario,in pa-tients who may be unf it for surgery.展开更多
Since its initial report in 1992,endoscopic ultrasoundguided fine needle aspiration(EUS-FNA) has now been incorporated into the diagnostic and staging algorithm for the evaluation of benign and malignant diseases of t...Since its initial report in 1992,endoscopic ultrasoundguided fine needle aspiration(EUS-FNA) has now been incorporated into the diagnostic and staging algorithm for the evaluation of benign and malignant diseases of the gastrointestinal tract and of adjacent organs.Its introduction constitutes a major breakthrough in the endoscopic field and has gradually transformed EUS from a pure imaging modality into a more interventional procedure.In addition,the possibility of collecting samples,providing a definitive cytological and/or histological evidence of the presence of malignancy,has strongly contributed to changing EUS from a subjective,highly operator dependant procedure into a more objective one.This article will review the instrumentation,technique and the most important clinical applications of EUS-FNA.展开更多
BACKGROUND Head pancreatic cancers often present with clinical challenges requiring biliary drainage for chemotherapy or palliative scope.If usual endoscopic modalities fail or if percutaneous approach is not feasible...BACKGROUND Head pancreatic cancers often present with clinical challenges requiring biliary drainage for chemotherapy or palliative scope.If usual endoscopic modalities fail or if percutaneous approach is not feasible,endoscopic ultrasound(EUS)guided biliary drainage can be considered.Here we describe and discuss an interesting clinical case in which EUS-guided gallbladder drainage(EUS-GBD)was chosen to treat acute severe cholangitis in a patient with advanced pancreatic cancer.CASE SUMMARY An 84-year-old female with a previous EUS-biopsy proven diagnosis of head pancreatic cancer presented with clinical signs of acute cholangitis.In September 2018 she had positioned a biliary and duodenal stent to relieve jaundice and an initial duodenal substenosis.In the emergency ward,an abdominal computed tomography scan showed proximal biliary stent occlusion due to neoplastic progression,but endoscopic retrograde cholangiopancreatography was impossible because of worsening duodenal stenosis and the absence of a chance to reach the Vater’s papilla area.EUS-guided choledocoduodenostomy was not technically feasible but because the cystic duct was free of neoplastic infiltration,an EUS-GBD using an Axios^TM stent was successfully performed.The patient started to feed after 48 h and was discharged 1 wk later.No other hospitalizations due to cholangitis or symptoms of Axios^TM stent occlusion/dysfunction were observed up until her death 6 mo later due to underlying disease.CONCLUSION This case demonstrated how different EUS therapeutic approaches could have a key role to treat critical and seemingly unsolvable situations and that they could play a more fundamental role in the next future.展开更多
文摘Some authors have suggested that intraductal papillary mucinous neoplasms of the bile duct(IPMN-B) could be the the biliary counterpart of IPMN of the pancreas(IPMN-P) since they share several clinical-pathological features.These include prominent intraductal papil-lary proliferation pattern,a gastrointestinal phenotype,frequent mucin hyper-secretion and progression to mu-cinous carcinoma.To date there are just four reported cases of patients with synchronous IPMN-B and IPMN-P all of which were treated surgically.We hereby report the case of a 76-year-old woman who was incidentally diagnosed with both an asymptomatic 3 cm bulky uid lesion obstructing the bile duct lumen,diagnosed as a malignant IPMN-B,and synchronous multiple pancreatic cystic lesions(10-13 mm) communicating with an irreg-ular Wirsung,diagnosed as branch duct IPMN-P.Since surgery was ruled-out because of the patient's age and preferences,she underwent a conservative manage-ment regimen comprising both chemotherapy and radio-therapy.This was effective in decreasing the mass size and in resolving subsequent jaundice.This is also the f irst reported case of IPMN-B successfully treated with chemoradiotherapy.Clinicians should consider medical treatment as an option in this clinical scenario,in pa-tients who may be unf it for surgery.
文摘Since its initial report in 1992,endoscopic ultrasoundguided fine needle aspiration(EUS-FNA) has now been incorporated into the diagnostic and staging algorithm for the evaluation of benign and malignant diseases of the gastrointestinal tract and of adjacent organs.Its introduction constitutes a major breakthrough in the endoscopic field and has gradually transformed EUS from a pure imaging modality into a more interventional procedure.In addition,the possibility of collecting samples,providing a definitive cytological and/or histological evidence of the presence of malignancy,has strongly contributed to changing EUS from a subjective,highly operator dependant procedure into a more objective one.This article will review the instrumentation,technique and the most important clinical applications of EUS-FNA.
文摘BACKGROUND Head pancreatic cancers often present with clinical challenges requiring biliary drainage for chemotherapy or palliative scope.If usual endoscopic modalities fail or if percutaneous approach is not feasible,endoscopic ultrasound(EUS)guided biliary drainage can be considered.Here we describe and discuss an interesting clinical case in which EUS-guided gallbladder drainage(EUS-GBD)was chosen to treat acute severe cholangitis in a patient with advanced pancreatic cancer.CASE SUMMARY An 84-year-old female with a previous EUS-biopsy proven diagnosis of head pancreatic cancer presented with clinical signs of acute cholangitis.In September 2018 she had positioned a biliary and duodenal stent to relieve jaundice and an initial duodenal substenosis.In the emergency ward,an abdominal computed tomography scan showed proximal biliary stent occlusion due to neoplastic progression,but endoscopic retrograde cholangiopancreatography was impossible because of worsening duodenal stenosis and the absence of a chance to reach the Vater’s papilla area.EUS-guided choledocoduodenostomy was not technically feasible but because the cystic duct was free of neoplastic infiltration,an EUS-GBD using an Axios^TM stent was successfully performed.The patient started to feed after 48 h and was discharged 1 wk later.No other hospitalizations due to cholangitis or symptoms of Axios^TM stent occlusion/dysfunction were observed up until her death 6 mo later due to underlying disease.CONCLUSION This case demonstrated how different EUS therapeutic approaches could have a key role to treat critical and seemingly unsolvable situations and that they could play a more fundamental role in the next future.
