Diagnosis of pancreatic tumors by endoscopic ultrasonography

Pancreatic tumors are highly diverse, as they can be solid or cystic, and benign or malignant. Since their imaging features overlap considerably, it is often difficult to characterize these tumors. In addition, small pancreatic tumors, especially those less than 2 cm in diameter, are difficult to detect and diagnose. For characterizing pancreatic tumors and detecting small pancreatic tumors, endoscopic ultrasonography (EUS) is the most sensitive of the imaging procedures currently available. This technique also provides good results in terms of the preoperative staging of pancreatic tumors. EUS-guided fine needle aspiration (EUS-FNA) has also proved to be a safe and useful method for tissue sampling of pancreatic tumors. Despite these advantages, however, it is still difficult to differentiate between be-nign and malignant, solid or cystic pancreatic tumors, malignant neoplasms, and chronic pancreatitis using EUS, even when EUS-FNA is performed. Recently, contrast-enhanced EUS with Doppler mode (CE-EUS) employing ultrasound contrast agents, which indicate vascularization in pancreatic lesions, has been found to be useful in the differential diagnosis of pancreatic tumors, especially small pancreatic tumors. However, Doppler ultrasonography with contrast-enhancement has several limitations, including blooming artifacts, poor spatial resolution, and low sensitivity to slow flow. Consequently, an echoendoscope was developed recently that has a broad-band transducer and an imaging mode that was designed specifically for contrastenhanced harmonic EUS (CEH-EUS) with a secondgeneration ultrasound contrast agent. The CEH-EUS technique is expected to improve the differential diagnosis of pancreatic disease in the future. This review describes the EUS appearances of common solid and cystic pancreatic masses, the diagnostic accuracy of EUS-FNA, and the relative efficacies and advantages of CE-EUS and CEH-EUS along with their relative advantages and their complementary roles in clinical practice.

Role of diabetes mellitus on the recurrence rate of hepatocellular carcinomas after radiofrequency ablation in chronic hepatitis C patients

Aim:The aim was to assess the impact of hyperglycemia on the recurrence of hepatocellular carcinoma(HCC)as well as evaluate survival after curative ablation by radiofrequency.Methods:This study,which was conducted retrospectively on 107 chronic hepatitis C(CHC)patients with 159 HCCs,was presented to the Hepatology Unit of Internal Medicine Department at Tanta University Hospitals.All lesions were curatively treated by radiofrequency ablation(RFA)and the surveillance of HCC recurrence was evaluated radiologically every 3 months for periods between 6 and 36 months.Of 107 subjects,70 were males and 37 were females,with mean age 50.4±9.4 years.All patients were divided according to their glycemic state into the following three groups:Group I,which included 37 type 2 diabetic patients,with adequate maintenance of blood glucose,has 52 HCCs;Group II,which included 25 type 2 diabetic patients with inadequate maintenance of blood glucose,has 43 HCCs;and Group III,which included 45 euglycemic non-diabetic patients,has 64 HCCs.Results:Our results showed that,there was signifi cant increase in recurrence rate in diabetic patients with inadequate maintenance of blood glucose(Group II)compared to those in Group I and Group III(P<0.0001).Interestingly,there was no signifi cant difference concerning HCC recurrence between diabetic patients with adequate maintenance of blood glucose(Group I)and non-diabetic euglycemic patients(Group III).Our results also identifi ed that,inadequate maintenance of blood glucose in diabetic patients was also a signifi cant predictor of poor survival.Conclusion:Inadequate maintenance of blood glucose in diabetic patients is a signifi cant risk factor for recurrence of HCC and for poor survival after curative RFA therapy in CHC patients.