Intraductal papillary mucinous tumor of the pancreas: ERCP, EUS, and pancreatoscopy findings

Venu, Rama P.; Atia, George; Brown, Russell D.; Rosenthal, Gayle M.

doi:10.1067/mge.2002.118959

Cited by 13 publications

(6 citation statements)

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“…IPMT occurs most frequently in older men and should be contiguous with the pancreatic ductal system on imaging. 25,36 MCN, on the other hand, occurs exclusively in women who are generally middle aged and should not be contiguous with the pancreatic ductal system. 37,38 SMA typically exhibits a honeycomb pattern or multiloculated cysts with a central scar and calcifications on imaging.…”

Section: Discussionmentioning

confidence: 99%

Indeterminate diagnosis in fine‐needle aspiration of the pancreas: Reasons and clinical implications

Payne¹,

Staerkel²,

Gong³

2008

Diagnostic Cytopathology

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An indeterminate diagnosis made on fine-needle aspiration (FNA) samples of the pancreatic lesions can cause dilemmas in clinical management. We retrospectively analyzed FNA features of such lesions in 65 consecutive pancreatic FNAs from 56 lesions to learn more about the sources of uncertainty and their clinical implications. A definitive diagnosis based on follow-up information was available in 50 lesions. Radiologically, 39% of the lesions showed a cystic component, and 25% of the lesions were ill-defined. Cytologically, contributing factors included scant atypical cells, coexistence of gastrointestinal epithelium, pancreatitis, poor cellular preservation, and interpretation error. Repeat sampling, as requested by clinicians prior to treatment, was performed in 33 (66%) of the 50 lesions, leading to a definitive pathologic diagnosis in 20 (61%) lesions. Seventeen lesions were eventually resected, of which a definitive preoperative diagnosis was attempted in 12 lesions via repeat sampling and was successful in seven. We concluded that indeterminate cytologic diagnosis of a pancreatic lesion often needs to be pursued for optimal management. Although intrinsic natures of a lesion such as cystic component may contribute to insufficient sampling, diagnostic certainty can be improved by proper specimen handling, interpretation, and clinical and/or radiographic correlation.

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Section: Discussionmentioning

confidence: 99%

Indeterminate diagnosis in fine‐needle aspiration of the pancreas: Reasons and clinical implications

Payne¹,

Staerkel²,

Gong³

2008

Diagnostic Cytopathology

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“…These elements probably influenced endoscopic performance: our 93.2% success rate (94.8% if incomplete procedures due to inadequate bowel preparation are disregarded) is definitely higher than at other endoscopy centers where deep sedation is not used [23], getting closer to the target indicated for screening examinations [24]. …”

Section: Discussionmentioning

confidence: 99%

Difficult colonoscopies in the propofol era

et al. 2012

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BackgroundTo study the relationship between endoscopic practice and adverse events during colonoscopy under standard deep sedation induced and monitored by an anesthetist.MethodsWe investigated the routine activity of an endoscopy center at the Padova University teaching hospital. We considered not only endoscopic and cardiorespiratory complications, but also the need to use high-dose propofol to complete the procedure, and the inability to complete the procedure. Variables relating to the patient’s clinical conditions, bowel preparation, the endoscopist’s and the anesthetist’s experience, and the duration of the procedure were input in the model.Results617 procedures under deep sedation were performed with a 5% rate of adverse events. The average dose of propofol used was 2.6±1.2 mg/kg. In all, 14 endoscopists and 42 anesthetists were involved in the procedures. The logistic regression analysis identified female gender (OR=2.3), having the colonoscopy performed by a less experienced endoscopist (OR=1.9), inadequate bowel preparation (OR=3.2) and a procedure lasting longer than 17.5 minutes (OR=1.6) as the main risk factors for complications. An ASA score of 2 carried a 50% risk reduction (OR=0.5).Discussion and conclusionsOur model showed that none of the variables relating to anesthesiological issues influenced which procedures would prove difficult.

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“…As with cholangioscopy, pancreatoscopy plays an important role in the work‐up of undiagnosed pancreatic ductal strictures or lesions 42–45 . The diagnostic yield of pancreatoscopy depends on factors such as endoscope caliber, fiber‐optic or electronic video imaging, and whether tissue sampling is available or not.…”

Section: Diagnostic Application Of Cholangiopancreatoscopymentioning

confidence: 99%

Application of per oral cholangiopancreatoscopy in pancreatobiliary diseases

Nguyen¹

2009

J of Gastro and Hepatol

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Pancreaticobiliary ductal diseases are largely investigated by indirect imaging techniques. Therefore, the pathology of up to 30% of cases remains undetermined. Cholangiopancreatoscopy allows direct visualization of ductal abnormalities with the ability to sample tissue and deliver a number of endotherapies. The technique can be broadly categorized into either two-operator or single-operator systems. Both systems provide important diagnostic information in the investigation of undetermined biliary or pancreatic strictures, intraductal papillary mucinous neoplasia, occult ductal malignant changes in patients with primary sclerosing cholangitis and occult intraductal stones in patients with complex biliary stone diseases. Therapeutically, cholangiopancreatoscopy-guided endotherapies provide a highly effective and safe alternative to surgery for patients with difficult extrahepatic and intrahepatic ductal stones that are not amenable to conventional endoscopic extraction by endoscopic retrograde cholangiopancreatography. The clinical application of cholangiopancreatoscopy, however, will be limited unless the technology is further refined to improve its durability, image quality, therapeutic capability and technical feasibility.

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Intraductal papillary mucinous tumor of the pancreas: ERCP, EUS, and pancreatoscopy findings

Cited by 13 publications

References 0 publications

Indeterminate diagnosis in fine‐needle aspiration of the pancreas: Reasons and clinical implications

Indeterminate diagnosis in fine‐needle aspiration of the pancreas: Reasons and clinical implications

Difficult colonoscopies in the propofol era

Application of per oral cholangiopancreatoscopy in pancreatobiliary diseases

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