AIMS: The main objective of this study was to determine the sensitivity of abdominal ultrasonography (US) in patients with isoattenuating pancreatic carcinoma and to compare the frequency of secondary signs on abdominal US and endoscopic ultrasonography (EUS) in these tumours. METHODS: Twenty-four patients with histologically or cytologically verified isoattenuating pancreatic carcinoma who underwent abdominal US, contrast-enhanced CT and EUS of the pancreas as part of the diagnostic workup were included in this retrospective study. The sensitivity of abdominal US in detecting the isoattenuating pancreatic carcinoma was investigated and the frequency of secondary signs of isoattenuating pancreatic carcinoma on abdominal US and EUS was compared. RESULTS: In 5 of 24 patients (21%) with isoattenuating pancreatic carcinoma, a hypoechogenic pancreatic lesion was directly visualised on abdominal US. Secondary signs were present on US in 21 patients (88%). These included dilatation of the common bile duct and/or intrahepatic bile ducts in 19/24 (79%), dilatation of the pancreatic duct in 3/24 (13%), abnormal contour/inhomogeneity of the pancreas in 1/24 (4%), and atrophy of the distal parenchyma in 1/24 (4%). Pancreatic duct dilatation was observed more frequently on EUS than on abdominal US (P=0.002). For other secondary signs, there was no significant difference in their detection on abdominal US and EUS (P=0.61-1.00). CONCLUSION: Abdominal US is capable of detecting secondary signs of isoattenuating pancreatic carcinoma with high sensitivity and has the potential to directly visualise these tumours.
INTRODUCTION: Pancreatic steatosis (PS) has both metabolic consequences and local effects on the pancreas itself. Magnetic resonance imaging (MRI) is the most reliable non-invasive method for diagnosing PS. We investigated the impact of metabolic syndrome (MS) on the presence of PS, differences in individuals with and without PS, and the metabolic effects of bariatric procedures. METHODS: Changes in anthropometric and basic biochemistry values and MS occurrence were evaluated in 34 patients with obesity who underwent a bariatric procedure. After the procedure, patients underwent MRI with manual 3D segmentation mask creation to determine the pancreatic fat content (PFC). We compared the differences in the PFC and the presence of PS in individuals with and without MS and compared patients with and without PS. RESULTS: We found no significant difference in the PFC between the groups with and without MS or in the occurrence of PS. There were significant differences in patients with and without PS, especially in body mass index (BMI), fat mass, visceral adipose tissue (VAT), select adipocytokines, and lipid spectrum with no difference in glycemia levels. Significant metabolic effects of bariatric procedures were observed. CONCLUSIONS: Bariatric procedures can be considered effective in the treatment of obesity, MS, and some of its components. Measuring PFC using MRI did not show any difference in relation to MS, but patients who lost weight to BMI < 30 did not suffer from PS and had lower overall fat mass and VAT. Glycemia levels did not have an impact on the presence of PS.
- MeSH
- bariatrická chirurgie * MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- metabolický syndrom * diagnostické zobrazování metabolismus MeSH
- morbidní obezita * chirurgie MeSH
- nitrobřišní tuk metabolismus MeSH
- obezita metabolismus MeSH
- pankreas diagnostické zobrazování metabolismus MeSH
- retrospektivní studie MeSH
- ztučnělá játra * patologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Úvod: Medzi ohraničené pankreatické tekutinové kolekcie patria pseudocysty a ohraničené pankreatické nekrózy (WOPN – walled-off pancreatic necrosis). Vznikajú ako komplikácie akútnej alebo chronickej pankreatitídy. Endoskopická transmurálna drenáž (ETD) je v súčasnosti metódou voľby v ich liečbe. Metodika: Vykonali sme retrospektívnu analýzu prospektívne zbieraných dát od pacientov, ktorí absolvovali ETD pseudocysty pankreasu alebo WOPN v jednom terciárnom gastroenterologickom centre počas intervalu 6 rokov. Zhodnotili sme technický úspech, krátkodobý a dlhodobý klinický úspech ETD ohraničených pankreatických tekutinových kolekcií. Porovnali sme efektivitu ETD vykonanej duodenoskopom (CTD) a echoendoskopom (EUD), pričom výber techniky spočíval v individuálnom rozhodnutí endoskopistu. Výsledky: V súbore 54 pacientov so symptomatickou pseudocystou alebo WOPN bol technický úspech ETD 94,4 % a nelíšil sa medzi EUD (100 %) a CTD (88,6 %) pri cielenej selekcii techniky (p = 0,104). Komplikácie sa vyskytli celkovo u 31,5 % pacientov, bez rozdielu medzi CTD a EUD (38,5 vs. 25 %; p = 0,382). Klinický efekt pretrvával 3 mesiace po inzercii drénov u 92,5 % pacientov s iniciálne technicky úspešnou drenážou a 6 mesiacov po extrakci drénov u 88,6 % pacientov s klinickým úspechom 3 mesiace po inzercii drénov, pričom sa nelíšil medzi EUD a CTD (3 mesiace po inzercii drénov: 90,5 vs. 94,8 %; p = 1,0; 6 mesiacov po extrakcii drénov: 100 vs. 77,8 %; p = 0,104). Z 51 pacientov s iniciálnou technicky úspešnou ETD pretrvával terapeutický efekt 6 mesiacov po extrakcii drénov u 62,7 % pacientov. Záver: Technický úspech, krátkodobý a dlhodobý klinický úspech ETD ohraničených pankreatických tekutinových kolekcií v súbore 54 pacientov bol 94,4, 92,5 a 88,6 %. Endosonografia má významnú úlohu v tejto terapii v prítomnosti žalúdočných varixov alebo neprítomnosti vyklenutia steny žalúdka. Pri cielenej selekcii techniky však nie je rozdiel v technickom a klinickom úspechu medzi EUD a CTD.
Introduction: Walled-off pancreatic fluid collections, that are categorized as pancreatic pseudocysts and walled-off pancreatic necrosis (WOPN), arise as complications of acute or chronic pancreatitis. Endoscopic transmural drainage (ETD) is the current method of choice for the treatment of symptomatic walled-off pancreatic fluid collections. Methods: A retrospective analysis of prospectively collected data from patients who underwent an ETD at a tertiary referral gastroenterological center during a 6-year interval was performed. The technical, short-and long-term clinical success of ETD of walled-off pancreatic fluid collections was evaluated. The effectiveness of ETD performed with two types of endoscopes, with a duodenoscope (CTD – conventional transmural drainage) and with an echoendoscope (EUD – endoscopic ultrasound-guided drainage), was also compared. The choice of technique was at the discretion of the endoscopist performing the procedure. Results: In a cohort of 54 patients with a symptomatic pseudocyst or WOPN, the overall technical success rate of ETD was 94.4%, and this did not differ between EUD (100%) and CTD (88.6%) when the appropriate technique was selected (p = 0.104). Complications occurred in 31.5% of the patients, with no difference found between CTD and EUD (38.5 vs. 25%; p = 0.382). Clinical success persisted 3 months after stent insertion in 92.5% of patients with initial technical success of ETD and 6 months after stent extraction in 88.6% of the patients with clinical success 3 months after stent insertion. No difference was observed between EUD and CTD (3 months after stent insertion: 90.5 vs. 94.8%; p = 1.0; 6 months after stent extraction: 100 vs. 77.8%; p = 0.104). Of 51 patients with initial technical success, the therapeutic effect 6 months after stent extraction was 62.7%. Conclusion: In a cohort of 54 patients, the technical success, short-term and long-term clinical success of ETD of walled-off pancreatic fluid collections was 94.4, 92.5 and 88.6%, respectively. Endoscopic ultrasound plays an important role in this therapy when gastric varices or a non-bulging fluid collection is involved. Furthermore, no difference was observed between EUD and CTD in terms of technical and clinical success when the appropriate technique was selected.
- Klíčová slova
- endoskopická drenáž,
- MeSH
- akutní nekrotizující pankreatitida * terapie MeSH
- dospělí MeSH
- drenáž metody MeSH
- endoskopie využití MeSH
- endosonografie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- pankreatická pseudocysta terapie MeSH
- pankreatitida * terapie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
