We report a successful endoscopic ultrasonographyguided drainage of a huge infected multilocular walledoff necrosis(WON) that was treated by a modified single transluminal gateway transcystic multiple drainage(SGTMD) ...We report a successful endoscopic ultrasonographyguided drainage of a huge infected multilocular walledoff necrosis(WON) that was treated by a modified single transluminal gateway transcystic multiple drainage(SGTMD) technique. After placing a widecaliber fully covered metal stent, follow-up computed tomography revealed an undrained subcavity of WON. A large fistula that was created by the wide-caliber metal stent enabled the insertion of a forward-viewing upper endoscope directly into the main cavity, and the narrow connection route within the main cavity to the subcavity was identified with a direct view, leading to the successful drainage of the subcavity. This modified SGTMD technique appears to be useful for seeking connection routes between subcavities of WON in some cases.展开更多
AIM:To investigate the impact of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)in association with a multidisciplinary team evaluation for the detection of gastrointestinal malignancies.METHODS:A cohort ...AIM:To investigate the impact of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)in association with a multidisciplinary team evaluation for the detection of gastrointestinal malignancies.METHODS:A cohort of 1019 patients with suspected malignant lesions adjacent to the gastrointestinal tract received EUS-FNA after a standardized multidisciplinary team evaluation(MTE)and were divided into 4 groups according to their specific malignant risk score(MRS).Patients with a MRS of 0(without detectable risk of malignancy)received only EUS without FNA.For patients with a MRS score ranging from 1(low risk)-through 2(intermediate risk)-to 3(high risk),EUS-FNA cytology of the lesion was planned for a different time and was prioritized for those patients at higher risk for cancer.The accuracy,efficiency and quality assessment for the early detection of patients with potentially curable malignant lesions were evaluated for the whole cohort and in the different classes of MRSs.The time to definitive cytological diagnosis(TDCD),accuracy,sensitivity,specificity,positive and negative predictive values,and the rate of inconclusive tests were calculated for all patients and for each MRS group.RESULTS:A total of 1019 patients with suspected malignant lesions were evaluated by EUS-FNA.In 515patients of 616 with true malignant lesions the tumor was diagnosed by EUS-FNA;421 patients with resectable lesions received early surgical treatment,and 94patients received chemo-radiotherapy.The overall diagnostic accuracy for the 1019 lesions in which a final diagnosis was obtained by EUS-FNA was 0.95.When patients were stratified by MTE into 4 classes of MRSs,a higher rate of patients in the group with higher cancer risk(MRS-3)received early treatment and EUSFNA showed the highest level of accuracy(1.0).TDCD was also shorter in the MRS-3 group.The number of patients who received surgical treatment or chemo-radiotherapy was significantly higher in the MRS-3 patient group(36.3%in MRS-3,10.7%in MRS-2,and 3.5%in MRS-1).CONCLUSION:EUS-FNA can effectively detect a curable malignant lesions at an earlier time and at a higher rate in patients with a higher cancer risk that were evaluated using MTE.展开更多
基金Supported by The Japan Society for the Promotion of Science and the Japanese Foundation for the Research and Promotion of Endoscopy,No.22590764 and No.25461035
文摘We report a successful endoscopic ultrasonographyguided drainage of a huge infected multilocular walledoff necrosis(WON) that was treated by a modified single transluminal gateway transcystic multiple drainage(SGTMD) technique. After placing a widecaliber fully covered metal stent, follow-up computed tomography revealed an undrained subcavity of WON. A large fistula that was created by the wide-caliber metal stent enabled the insertion of a forward-viewing upper endoscope directly into the main cavity, and the narrow connection route within the main cavity to the subcavity was identified with a direct view, leading to the successful drainage of the subcavity. This modified SGTMD technique appears to be useful for seeking connection routes between subcavities of WON in some cases.
文摘AIM:To investigate the impact of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)in association with a multidisciplinary team evaluation for the detection of gastrointestinal malignancies.METHODS:A cohort of 1019 patients with suspected malignant lesions adjacent to the gastrointestinal tract received EUS-FNA after a standardized multidisciplinary team evaluation(MTE)and were divided into 4 groups according to their specific malignant risk score(MRS).Patients with a MRS of 0(without detectable risk of malignancy)received only EUS without FNA.For patients with a MRS score ranging from 1(low risk)-through 2(intermediate risk)-to 3(high risk),EUS-FNA cytology of the lesion was planned for a different time and was prioritized for those patients at higher risk for cancer.The accuracy,efficiency and quality assessment for the early detection of patients with potentially curable malignant lesions were evaluated for the whole cohort and in the different classes of MRSs.The time to definitive cytological diagnosis(TDCD),accuracy,sensitivity,specificity,positive and negative predictive values,and the rate of inconclusive tests were calculated for all patients and for each MRS group.RESULTS:A total of 1019 patients with suspected malignant lesions were evaluated by EUS-FNA.In 515patients of 616 with true malignant lesions the tumor was diagnosed by EUS-FNA;421 patients with resectable lesions received early surgical treatment,and 94patients received chemo-radiotherapy.The overall diagnostic accuracy for the 1019 lesions in which a final diagnosis was obtained by EUS-FNA was 0.95.When patients were stratified by MTE into 4 classes of MRSs,a higher rate of patients in the group with higher cancer risk(MRS-3)received early treatment and EUSFNA showed the highest level of accuracy(1.0).TDCD was also shorter in the MRS-3 group.The number of patients who received surgical treatment or chemo-radiotherapy was significantly higher in the MRS-3 patient group(36.3%in MRS-3,10.7%in MRS-2,and 3.5%in MRS-1).CONCLUSION:EUS-FNA can effectively detect a curable malignant lesions at an earlier time and at a higher rate in patients with a higher cancer risk that were evaluated using MTE.