No abstract

Scirrhous gastric cancer (SGC) is diagnosed using endoscopy and/or biopsy; however, SGC diagnosis remains challenging owing to its special growth form and morphologic features. Hence, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), which is minimally invasive and has a high proportion of diagnostic tissue, may be an alternative investigative modality for patients with suspected SGC. This systematic review and meta-analysis aimed to identify and evaluate the evidence for the efficacy and safety of EUS-FNA in patients with suspected SGC. We conducted a systematic review using the PubMed (MEDLINE) and Ichushi-Web (NPO Japan Medical Abstracts Society) databases and included all entries in which SGC was evaluated using EUS-FNA in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement from the databases 0 inception to October 10, 2022. The primary outcome was the proportion of SGC diagnosed using EUS-FNA. In addition, we analyzed the proportion of adverse events associated with EUS-FNA. The electronic search identified 1890 studies; overall, four studies met the selection criteria and reported data on EUS-FNA performed on 114 patients with suspected SGC. The overall diagnostic yield of EUS-FNA for SGC was 82.6% (95% confidence interval, 74.6-90.6%) and the statistical heterogeneity was 0% (I 2 = 0%), indicating a low heterogeneity. Furthermore, the EUS-FNA diagnostic proportion for SGC lymph node metastasis was 75-100%, indicating a high diagnostic performance. The adverse event rate of EUS-FNA was 0%. EUS-FNA may be an alternative investigation mode for SGC patients with negative esophagogastroduodenoscopy-biopsy results.

Endoscopic hemostasis is the first step in cessation of gastrointestinal bleeding.Although IVR may sometimes be required for preventing rebleeding, prophylactic IVR was not considered necessary in this case because of complete endoscopic hemostasis.

COVID-19 afflicts patients with acute symptoms and longer-term sequelae. One of the sequelae is myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which is often difficult to diagnose, having no established tests. In this article, we synthesize information from literature reviews on patients with ME/CSF that developed after recovery from COVID-19.

Background The role of computed tomography (CT) in the initial diagnosis of pancreatic cancer (PC) is well-known. CT reports made by radiologists are important as not all patients with PC are examined by specialists; however, some cases are not identified based on CT reports. Diagnosis via imaging of PC is sometimes difficult, and the diagnostic rate of PC and other pancreatic diseases can vary across radiologists. This study examined the diagnostic rate of PC in initial CT reports and the details of cases with diagnostic difficulties. Methods Clinical data of 198 patients with histologically diagnosed PC were retrospectively collected between January 2018 and April 2022. Out of these contrast-enhanced CT was performed in 192 cases (124 men and 68 women) and these cases were examined. Results In the reports, PC was not reported as the main diagnosis in 18 patients (9.4%; 11 men and 7 women; mean age, 69.7 years). Among these 18 cases, intrapancreatic mass lesions were detected in 3 (1.6%), indirect findings such as bile duct/pancreatic duct stenosis or dilation were detected in 5 (2.6%), and no PC-related findings were found in 10 (5.2%). The specialists suspected PC in 15 of these 18 cases based on initial CT reports. Seventeen cases were confirmed by endoscopic ultrasound-fine needle aspiration (EUS-FNA) and one by biopsy after upper gastrointestinal endoscopy. Conclusions To improve accuracy of the diagnosis of the PC, it is important that specialists provide feedback to diagnostic radiologists regarding the findings they did not report. Additionally, non-specialists should be aware of the importance to seek the advice of specialists when such indirect findings or any kind of pancreatic mass are present. EUS-FNA should be performed by specialists when there is clinical information which indicates pancreatic disease of any kind.