BACKGROUND: Endosonography-guided fine needle aspiration biopsy (EUS-FNA)-associated metachronous gastric seeding metastases (GSM) of pancreatic ductal adenocarcinoma (PDAC) represent a serious condition with insufficient evidence. METHODS: Retrospective analysis of PDAC resections with a curative-intent, proven pathological diagnosis of PDAC, preoperative EUS-FNA and post-resection follow-up of at least 60 months. The systematic literature search of published data was used for the GSM growth evaluation using Pearson correlation and the linear regression analyses. RESULTS: The inclusion criteria met 59/134 cases, 16 (27%) had retained needle tract (15 following distal pancreatectomy, 1 following pylorus-sparing head resection). In total, 3/16 cases (19%) developed identical solitary GSM (10-26th month following primary surgery) and were radically resected. A total of 30 published cases of PDAC GSM following EUS-FNA were identified. Lesion was resected in 20 distal pancreatectomy cases with complete information in 14 cases. A correlation between the metastasis size and time (r = 0.612) was proven. The regression coefficient b = 0.72 expresses the growth of 0.72 mm per month. CONCLUSIONS: The GSM represent a preventable and curable condition. A remarkably high number of GSM following EUS-FNA was identified, leading to follow-up recommendation of EUS-FNA sampled patients. Multimodal management (gastric resection, adjuvant chemotherapy) may prolong survival.

• Publikační typ
• časopisecké články MeSH

BACKGROUND: The management and prognosis of subepithelial tumors (SETs) of the upper gastrointestinal tract depend on the correct preoperative evaluation, including tissue diagnosis in selected cases. Several methods providing deep tissue sampling for cytological and/or histological examinations have been described but their diagnostic yield and precise position in the diagnostic algorithm remain to be established. This prospective randomized study aims to compare the Endosonography-Guided Fine-Needle Aspiration (EUS-FNA) to Key-Hole Biopsy (KHB) in cytological or histological diagnostics of upper gastrointestinal SETs. PATIENTS AND METHODS: This study was conducted in a single tertiary endoscopy center in Ostrava, Czech Republic between November 2010 and October 2015. Patients with endoscopically detected SETs of the upper gastrointestinal tract with a diameter ≥ 2 cm, were randomized to either the EUS-FNA with 22G needle, or to the Key Hole biopsy (forceps biopsy through mucosal incision) groups. The main study outcomes were success rate of tissue diagnostics and, in the cases of Gastrointestinal Stromal Tumours (GIST), possibility of determining mitotic activity. A cross-over examination was performed in situations where the first method had failed. RESULTS: A total of 46 consecutive patients were randomized. Of these, 24 (52%) and 22 (48%) were randomized to EUS-FNA group and KHB arm, respectively. 5 SETs (11%) were detected in the esophagus, 40 (87%) in the stomach and 1 (2%) in the duodenum. The definitive diagnosis was established by the first sampling method in 42 (91%) patients, including 22 (92%) in the EUS-FNA group and 20 (91%) in the KHB group (P=0.999), and after a cross-over in another 3 (7%) patients. The most prevalent SET was GIST (70%). Although some mitotic activity could be observed in 11 patients, the mitotic index could be diagnosed in none of them. Of a total of 20 surgically treated patients, preoperative and postoperative tissue diagnosis corresponded in 19/20 (95%) cases, including 100% in FNA group and 91% in KHB group (P=0.999). No adverse events of tissue sampling occurred in the study. CONCLUSIONS: Deep tissue sampling by EUS-FNA and KHB are equally effective in the diagnostics of SETs of the upper gastrointestinal tract ≥ 2 cm. However, neither EUS-FNA nor KHB provided adequate tissue sample to determine mitotic index. TRIAL REGISTRATION: Clinicaltrials.gov (NCT02025244).

• MeSH
• biopsie tenkou jehlou pod endosonografickou kontrolou * MeSH
• endosonografie * MeSH
• gastrointestinální nádory diagnostické zobrazování   patologie   MeSH
• gastrointestinální stromální tumory diagnostické zobrazování   patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mitotický index MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• studie proveditelnosti MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika MeSH

OBJECTIVES: Biliary strictures frequently present a diagnostic challenge. The aim of this study was to evaluate the impact of digital single-operator cholangioscopy (DSOC) on subsequent treatment of patients with biliary stricture. METHODS: Consecutive patients undergoing DSOC for biliary stricture were enrolled. Gold standard for final diagnosis included histology from surgical resection. In patients without surgery, clinical evaluation methods and repeated imaging studies were used for comparison of DSOC findings and final diagnosis. Patients were followed-up prospectively focusing on subsequent treatment. RESULTS: Among 30 enrolled patients, final diagnosis was malignant in 13 (43%) and benign in 17 (57%). The sensitivity and specificity of visual impression in diagnosing malignant stricture were 100% (95% CI: 75 - 100) and 76% (95% CI: 50 - 93), respectively. The sensitivity and specificity for biopsy were 92% (95% CI: 62 - 100) and 100% (95% CI: 78 - 100), respectively. One (3%) case of complicating cholangitis with fatal outcome occurred. Final treatment included surgery in 7 (23%), endoscopy in 18 (60%) and chemotherapy in 3 (10%) of patients. CONCLUSIONS: In this study, favorable operating characteristics of DSOC were confirmed. Absolute negative predictive value of visual impression provided reassurance to patients with benign strictures who avoided unnecessary surgery in 53%. One (3%) case of cholangitis with fatal outcome occurred.

• MeSH
• biopsie MeSH
• chirurgie žlučových cest přístrojové vybavení   metody   MeSH
• cholangiografie přístrojové vybavení   metody   MeSH
• design vybavení MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci žlučových cest diagnóza   chirurgie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• stenóza diagnóza   etiologie   MeSH
• výsledek terapie MeSH
• žlučové cesty intrahepatální * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

Adenóm Brunnerových žliaz je zriedkavý benígny nádor duodéna, často diagnostikovaný náhodne počas hornej endoskopie alebo röntgenovým vyšetrením. Väčšina týchto lézií je asymptomatická, malý počet sa môže prezentovať symptómami duodenálnej obštrukcie alebo krvácaním zo sekundárnej ulcerácie. Histologicky je adenóm Brunnerových žliaz tvorený komponentami buniek Brunnerových žliaz, ako aj žľazovými, tukovými a svalovými bunkami. Prezentovaný je prípad 53-ročnej pacientky s adenómom Brunnerových žliaz s priemerom 3,5 cm, ktorý sa klinicky manifestoval ako krvácanie z horného gastrointestinálneho traktu. V rámci diagnostiky bolo realizované endosonografické vyšetrenie, pri ktorom bol zobrazený bohato vaskularizovaný nádor vychádzajúci zo submukózy duodéna. Po histologickom vyšetrení materiálu získaného endosonograficky navigovanou aspiračnou biopsiou bol hamartóm úspešne odstránený endoskopickou polypektómiou s použitím endoloopu. V diskusii je uvedený prehľad lietratúry, vrátane možností liečby týchto lézií.

Brunner´s gland adenomas are rare benign tumors of the duodenum, which are often diagnosed incidentally during esophagogastroduodenoscopy or upper gastrointestinal series. The lesions are most commonly asymptomatic, but a minority of patients may present with symptoms of duodenal obstruction or hemorrhage secondary to ulceration. Histologically, a Brunner´s gland adenoma consists of components of Brunner´s gland cells, as well as glandular, adipose and muscle cells. We report a case of a 53-year-old woman with a Brunner´s gland adenoma with a size of 3.5 cm, causing an upper gastrointestinal bleeding. Endosonography revealed a highly vascularized duodenal tumor arising from the submucosa. After histological examination of an endosonographically guided fine needle aspiration biopsy revealed a Brunner´s gland adenoma, the adenoma was successfully removed using a polypectomy snare and an endoloop. We also present a literature review, including other therapy options.

• MeSH
• adenom diagnóza   MeSH
• biopsie tenkou jehlou pod endosonografickou kontrolou MeSH
• Brunnerovy žlázy * patologie   MeSH
• diferenciální diagnóza MeSH
• endoskopie MeSH
• gastrointestinální krvácení * diagnóza   etiologie   MeSH
• hamartom diagnóza   terapie   MeSH
• kolorektální nádory diagnóza   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• meléna MeSH
• nemoci duodena diagnóza   MeSH
• polypy střeva diagnóza   chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH

• MeSH
• bariatrie přístrojové vybavení   MeSH
• gastroezofageální reflux terapie   MeSH
• gastrointestinální endoskopie * metody   přístrojové vybavení   MeSH
• lidé MeSH
• polypy střeva diagnóza   chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy 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