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A problem swallowing
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
In comparison with CT, endoscopic ultrasound gives more in-depth information about the local extent of the tumour. A high-frequency ultrasound transducer provides detailed images of the oesophageal lesion, the surrounding oesophageal wall and local lymph node involvement.
Chronic Pancreatitis: Small Duct Disease with Uncontrolled Pain
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Michael F. Nentwich, Jakob R. Izbicki
Endoscopic ultrasound: Requires planning and patient preparation. In endoscopic ultrasound, pancreatic changes are detectable earlier than with endoscopic retrograde cholangiopancreatography (and possibly magnetic resonance cholangiopancreatography). With endoscopic ultrasound, the parenchymal as well as ductal changes can be visualized and classified using the “Rosemont criteria” to assess for a chronic pancreatitis. It additionally offers the option of endoscopic ultrasound-guided puncture of areas of interest, such as fluid aspiration of cystic lesions. Endoscopic ultrasound harbors the risks of any endoscopic examination with rare incidences of severe complications, unless invasive procedures such as punctures are performed.
Gastrointestinal cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
This is the investigation of choice. The oesophagus starts at the lower border of the cricoid cartilage at the level of the sixth cervical vertebra, approximately 15 cm from the incisor teeth. It is 25 cm in length, entering the stomach at the level of the tenth thoracic vertebra (i.e. approximately 40 cm from the incisors). Endoscopy allows a thorough assessment of the whole oesophagus. The tumour can be visualized directly, a biopsy taken for histology and brushings for cytology. It also allows a thorough evaluation of the stomach, which is particularly important in tumours of the lower third of the oesophagus, and is the most sensitive means of detecting small primary tumours and skip lesions. Endoscopic ultrasound is also a useful tool, allowing direct imaging of the tumour. It is particularly sensitive for determining the depth of invasion and involvement of first station lymph node groups.
Endoscopic ultrasound with combined fine needle aspiration plus biopsy improves diagnostic yield in solid pancreatic masses
Published in Scandinavian Journal of Gastroenterology, 2022
Adalberto Gonzalez, Vaibhav Wadhwa, Harjinder Singh, Sikandar Khan, Kapil Gupta, Hong Liang, Ishtiaq Hussain, John Vargo, Sunguk Jang, Prabhleen Chahal, Amit Bhatt, Hassan Siddiki, Tolga Erim, Madhusudhan R. Sanaka
We performed a retrospective chart review of all patients who underwent endoscopic ultrasound (EUS) by the senior author (MRS) at the Cleveland Clinic between January 2014 and September 2019. We included all adult patients who underwent either EUS-FNA or EUS-FNA + FNB for solid pancreatic or peri-pancreatic masses for the first time. We excluded all patients who underwent EUS for other indications and those who were undergoing a repeat FNA or FNB due to a previously non-diagnostic procedure. Senior author MRS performed standard EUS-FNA for SPMs until September 2016, and subsequently started the combination technique (EUS-FNA + FNB) for all SPMs. Hence, the patients were divided into two groups. EUS-FNA group comprising EUS procedures during the period January 2014–September 2016 and Combined EUS-FNA + FNB group comprising EUS procedures performed during the period October 2016–September 2019. This study was approved by the Institutional Review Board (IRB) at Cleveland Clinic.
Extranodal Extension in Esophageal Cancer: Does It Belong in the TNM System?
Published in Journal of Investigative Surgery, 2022
Konstantinos S. Mylonas, Dimitrios Schizas
This growing body of literature is making a compelling argument toward incorporating ENE in the TNM staging system of esophageal carcinomas. According to the data herein presented in the Journal of Investigative Surgery, the absolute number of affected lymph nodes did not itself affect survival [1]. Therefore, if ENE was incorporated into the TNM staging system, it should be based on its presence in cases with early pN status, rather than the absolute number of lymph nodes with ENE. We also argue that radiologic evaluation of extranodal extension could provide actionable information to multidisciplinary tumor boards debating whether to administer neoadjuvant chemotherapy or chemoradiation to gray zone lesions such as T1b or T2 [7]. Although no esophageal data are available to date, there is extensive experience in oropharyngeal cancers to draw from [8]. For example, when looking at head & neck SCC (HNSCC), the sensitivity and specificity for computed tomography (CT) were nearly 75% and 85%, respectively compared to 60% and 96% for magnetic resonance imaging. On imaging, infiltration of adjacent fatty tissue constitutes a highly specific marker of ENE, while central node necrosis seems to be highly sensitive [9]. Furthermore, a SUVmax cutoff of 3.0 on positron emission tomography-CT seems to identify ENE in HNSCC with specificity and sensitivity of 94.3% and 81.1%, respectively [10]. Similar imaging performance metrics could be reproducible in esophageal cancer. Additional guidance could be provided using endoscopic ultrasound.
The application of endoscopic loop ligation in defect repair following endoscopic full-thickness resection of gastric submucosal tumors originating from the muscularis propria layer
Published in Scandinavian Journal of Gastroenterology, 2022
Guoxiang Wang, Yanli Xiang, Yangde Miao, Honggang Wang, Meidong Xu, Guang Yu
Postoperative care should not be ignored and is essential in the recovery of patients and as a means to reduce the occurrence of complications. First, the patient is required to adopt a high semi-recumbent position immediately after the operation and accept indwell gastrointestinal decompression, while nursing staff must closely monitor changes in vital and abdominal signs. Second, control of the patient's diet is also very important. On the first postoperative day, patients were required to strictly fast and were given anti-inflammatory and acid-suppressing treatments to promote wound healing; on the second postoperative day, if no bleeding, obvious abdominal symptoms (e.g., abdominal pain, bloating), abdominal signs (e.g., abdominal wall tenderness), or intestinal peristalsis (i.e., bowel sounds can be restored or there is exhaust and defecation) were observed, the gastrointestinal decompression can be stopped and fluid can be introduced. Endoscopic ultrasound and computed tomography can be performed on the third day after surgery. To understand whether there is abdominal and pelvic effusion, if there are no positive findings, cold and soft food could be consumed on the third day and the patient may be gradually transitioned to a normal diet.