Duplication cysts are rare gastrointestinal congenital abnormalities. They can occur anywhere throughout the gastrointestinal tract, and gastric duplication cysts are most uncommon, representing only 4-8% of all gastrointestinal duplication cysts. Nowadays several theories try to explain the pathogenic mechanisms involved. These cysts are usually diagnosed during early childhood, and very rarely are detected in adults, mostly incidentally due to a lack of symptoms. Close to 50% of gastric cysts are associated with other abnormalities. It is extremely important that a meticulous differential diagnosis is performed regarding other diseases, mainly malignancies with a cystic component. Although extremely uncommon, a malignant transformation of these lesions has been reported, which highlights the importance of a correct diagnosis. Herein we report the case of a duplication cyst in an adult, which was detected by endoscopic ultrasound-guided fine-needle aspiration, recently proposed as the most accurate technique for the identification of these lesions.

Pancreatic cancer is the 5 th leading cause of cancer-related death in Western countries. The 5-year survival rate is approximately 4%, without significant changes over the last 50 years. This poor survival rate and bad prognosis are associated with the diagnosis of advanced-stage disease, which precludes the only potential curative treatment-surgical resection. In this setting, the main objective in the management of pancreatic cancer is to perform an early diagnosis and a correct staging of the disease. Endoscopic ultrasonography (EUS) appears to be an essential tool for the diagnosis and staging of pancreatic cancer. EUS diagnostic accuracy for detecting pancreatic tumors ranges from 85 to 100%, clearly superior to other imaging techniques. EUS accuracy for the local staging of pancreatic cancer ranges from 70 to 90%, superior or equivalent to other imaging modalities. EUSguided fine-needle aspiration allows a cyto-histological diagnosis in nearly 90% of cases, with a very low complication rate. At present, the formal indications for EUS-guided fine-needle aspiration are the necessity of palliative treatment or whenever the possibility of neoadjuvant treatment is present. It could be also indicated to differentiate pancreatic adenocarcinoma from other pancreatic conditions, like lymphoma, metastasis, autoimmune pancreatitis or chronic pancreatitis. We can conclude that EUS is an essential tool in the management of patients with pancreatic tumors.

Gastrointestinal symptoms in patients with SLE are common, specifically abdominal pain. However, the rate of pancreatic diseases is much lower and does not reach 5% according to published series in Europe and the USA. This association between SLE and pancreatic disease is basically at the expense of episodes of acute pancreatitis. An association with chronic pancreatitis is much more uncommon, and only four articles have been published showing this relationship.Three cases of SLE-associated pancreatitis are described, and disease onset, etiological factors, and clinical progression are analyzed. A review of the literature and a brief discussion about pathophysiological mechanisms and the role of corticosteroids are also included.Key words: Systemic lupus erythematosus. Acute pancreatitis. Chronic pancreatitis. INTRODUCTIONSince the first association between systemic lupus erythematosus (SLE) and pancreatitis was documented by Reifenstein et al. in 1939 (1), very few reports about the prevalence of pancreatic diseases in this rheumatologic disorder have been reported.Gastrointestinal symptoms in patients with SLE are common, specifically abdominal pain; as described in some series, it has been shown to have a prevalence of 19.2% (2). The rate of pancreatitis in patients with SLE varies depending on individual series from Europe and the United States between 0.7 and 4% (3,4). This association is mainly at the expense of acute episodes of pancreatitis; however only four reports have been published regarding this relationship with chronic pancreatitis (5-7).Three cases of SLE-associated pancreatitis are described, and disease onset, etiological factors and clinical progression are analyzed. A review of the literature and a brief discussion about the pathophysiological mechanisms and the role of corticosteroids are also included. METHODSA retrospective review of hospital admissions at Gastroenterology Department, University Hospital, Santiago de Compostela during 2001-2005 with the dual diagnosis of systemic lupus erythematosus and pancreatitis was made. Demographic data, clinical intervention, and progression parameters of pancreatic disease were identified. These patients were collected by searching our institution's computer database using the key words "pancreatitis" and "SLE". Demographic information registered from the medical charts included subject age, gender, time (years) from the initial diagnosis of SLE, alcohol abuse, medications, specially corticosteroids, and criteria used for SLE diagnosis.Clinical data collected included symptoms, SLE activity with a list of organs or systems involved, initial pancreatic enzymes, number of admissions for pancreatitis, and serologies for antinuclear antibodies (ANA) and C-reactive protein levels. All radiological results were documented, including abdominal ultrasounds, helical CT, cholangiopancreatic resonance (MRPC), endoscopic retrograde cholangiopancreatography (ERPC), and endoscopic ultrasounds (EUS

No abstract

Endoscopic ultrasonography (EUS) is considered one of the most accurate methods for the diagnosis and staging of pancreatic tumors. EUS-guided fine-needle aspiration (FNA) allows to increase the diagnostic accuracy of EUS in this setting; however, it is technically demanding (a pathologist is also essential) and is furthermore associated with small, but not insignificant morbidity. EUS pancreatic elastography, by analyzing tissue stiffness, arises as a new and very useful tool for the differential diagnosis of solid pancreatic masses. Elastography provides specific patterns supporting the benign or malignant nature of the disease. However, there is a handicap related to the subjective interpretation of images. Second-generation elastography has been recently developed, and allows a quantitative analysis of tissue stiffness. It is based on the determination of a strain ratio (obtained after comparing the strain value of the mass to a strain value from a control area in the region under study). We present two cases reflecting the usefulness of second-generation elastography in the differential diagnosis between pancreatic adenocarcinoma and an inflammatory mass in the context of chronic pancreatitis. We found significant differences between both masses in the strain ratio values (25.46% in the pancreatic adenocarcinoma vs. 2.35% in the inflammatory mass). Second-generation elastography is a very useful tool for the differential diagnosis of solid pancreatic masses.Key words: Endoscopic ultrasound. Elastography. Second-generation Elastography. Pancreatic tumors. INTRODUCTIONEndoscopic ultrasonography (EUS) has become a basic tool for the study of pancreatic diseases, and is considered one of the most accurate methods for the diagnosis and staging of both chronic inflammatory and neoplastic pancreatic diseases (1,2). However, differentiation between pancreatic cancer and focal pancreatitis remains a challenge. EUS can guide fine-needle aspiration (EUS-FNA) for the collection of cytological samples from pancreatic lesions with a very high overall diagnostic accuracy (3-7). EUS-FNA may be, however, technically demanding, and multiple puncturing of pancreatic lesions may be needed to obtain adequate material for cytological or microhistological evaluation. EUS-FNA of the pancreas, despite being considered very safe, is furthermore associated with a small, but not insignificant morbidity (8,9).Elastography is a method for the real-time evaluation of tissue stiffness, which has been used for the analysis of superficial organ lesions such as those of the breast (10-13). Images obtained by elastography represent tissue elasticity, which may reflect histopathological differences (14). The association of this technology with EUS has implied a significant advance in the management of pancreatic diseases, mainly in the differential diagnosis of pancreatic tumors (15). A new advance has been recently developed -secondgeneration elastography. This technique allows not only a qualitative elastographic analysis, but also a...