César Lopes - Academia.edu (original) (raw)
Papers by César Lopes
Journal of the Pancreas, 2018
Purpose Imaging diagnosis of SPN is difficult. Preoperative diagnosis by EUS-FNA) is possible, sa... more Purpose Imaging diagnosis of SPN is difficult. Preoperative diagnosis by EUS-FNA) is possible, safe, and has been reported in the literature. However, its usefulness is still controversial. The aim of this study was to determine the accuracy of the EUS-FNA and imaging findings in CT and MRI/MRCP exams in the diagnosis of patients with SPN. Methods We retrospectively reviewed the medical records of patients undergoing EUS-FNA with suspected diagnosis of SPN on imaging studies in 5 high-volume hospitals. The final diagnosis was obtained after the histological examination of the surgical specimen. Demographic data, CT, MRI and EUS findings, anatomopathological specimen and McH results obtained by EUS were analyzed. Results Fifty-four patients were included, of which 49 (90.7%) were women with an average age of 33.4 (range 11–78) years. The most common symptom presented was abdominal pain, present in 35.2%. SPN was detected incidentally in 32 (59%). The mean size of the tumors was 3.8 c...
Supportive Oncology, 2011
World Journal of Gastroenterology, 2008
ABCD, Jun 21, 2018
Background: Tissue diagnosis is required for gastric subepithelial lesions for differential diagn... more Background: Tissue diagnosis is required for gastric subepithelial lesions for differential diagnosis of GISTs. However, there has not been consensus about the best needle for EUS-guided sampling of these lesions. Aim: To evaluate the diagnostic yield of EUS-FNA for gastric subepithelial lesions of the proper muscle layer with large-bore 19 gauge needles. Methods: A prospectively maintained database was retrospectively reviewed to identify consecutive patients who underwent EUS-FNA with 19 and 22 gauge needles for gastric subepithelial lesions of the fourth endosonographic layer in a tertiary care referral center. EUS-FNA was performed by the same endosonographer, using the fanning technique, without on-site cytopathologist. Specimens were analysed through cell blocks by the same pathologist. Procedure results were categorized into diagnostic, defined as enough material for histopathology and immunohistochemistry, or nondiagnostic. Results: Eighty-nine patients (mean age: 59 years, 77% women) underwent 92 EUS-FNA with 19 (75) or 22 (17) gauge needles. Mean lesion size was 22.6 mm. Overall diagnostic yield was 88%. The diagnostic yield of 19 gauge was higher than that of 22 gauge needle (92%x70.6%; p=0.0410), and similar for lesions >2 cm and <2 cm (93.7%x90.7%; p=0.9563). The best performance for 19 gauge needles was obtained performing <3 needle passes. Complication rate was 2.8%. Conclusions: Diagnostic yield of EUS-FNA with 19 gauge needles is 92% for gastric subepithelial lesions of the proper muscle layer. It is safe and highly valuable for differentiation between GIST and leiomyoma, no matter the size of the lesion.
Endoscopic ultrasound, Jan 6, 2017
Arquivos de Gastroenterologia, 2013
ContextPancreatic splenosis is a benign condition which can mimic a pancreatic neoplasm.Objective... more ContextPancreatic splenosis is a benign condition which can mimic a pancreatic neoplasm.ObjectiveTo describe the role of the endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic nodules suspicious for pancreatic splenosis.MethodFrom 1997 to 2011, patients with pancreatic solid tumors suspicious for splenosis by computed tomography and/or magnetic resonance imaging were referred to EUS-FNA. Those cases with pancreatic splenosis confirmed by EUS-FNA or surgery were included. Endosonographic findings and clinicopathologic features were also analysed.ResultsA total of 2,060 patients with pancreatic solid tumors underwent EUS-FNA. Fourteen (0.6%) cases with pancreatic splenosis were found. After applying exclusion criteria, 11 patients were selected. Most patients were male (7), young (mean age: 42 years) and asymptomatic (8). Endoscopic ultrasound imaging alone suspected pancreatic splenosis in 6 cases, and neuroendocrine tumors in 5 cases. Pancreatic splenosis wa...
Arquivos de Gastroenterologia, 2014
Context The size of colorectal lesions, besides a risk factor for malignancy, is a predictor for ... more Context The size of colorectal lesions, besides a risk factor for malignancy, is a predictor for deeper invasion Objectives To evaluate the malignancy of colorectal lesions ≥20 mm. Methods Between 2007 and 2011, 76 neoplasms ≥20 mm in 70 patients were analyzed Results The mean age of the patients was 67.4 years, and 41 were women. Mean lesion size was 24.7 mm ± 6.2 mm (range: 20 to 50 mm). Half of the neoplasms were polypoid and the other half were non-polypoid. Forty-two (55.3%) lesions were located in the left colon, and 34 in the right colon. There was a high prevalence of III L (39.5%) and IV (53.9%) pit patterns. There were 72 adenomas and 4 adenocarcinomas. Malignancy was observed in 5.3% of the lesions. Thirty-three lesions presented advanced histology (adenomas with high-grade dysplasia or early adenocarcinoma), with no difference in morphology and site. Only one lesion (1.3%) invaded the submucosa. Lesions larger than 30 mm had advanced histology (P = 0.001). The primary tr...
An increased frequency of digestive hemorrhage from nonvariceal sources is descri- bed after vari... more An increased frequency of digestive hemorrhage from nonvariceal sources is descri- bed after variceal ligation. The aim of this study is to verify the impact of the eradication of esophageal varices by endoscopic ligation on the portal pressure gradient. Twenty-two cirrhotics (15M/7F, mean age: 54.5 years) with previous variceal bleeding were submit- ted to measurement of hepatic venous pressure gradient before and after variceal eradi- cation by endoscopic ligation. The mean hepatic venous pressure gradient in the first measurement was 14.1mmHg and after eradication, 13.5mmHg (p=0.403). After eradica- tion, 12 patients experienced a reduction in portal pressure and 10, an elevation. We conclude that esophageal variceal eradication by endoscopic band ligation does not alter the hepatic venous pressure gradient.
Arquivos de Gastroenterologia, 2009
CONTEXTO: O uso da cromoscopia virtual com sistema de imagem multibanda poderia auxiliar no diagn... more CONTEXTO: O uso da cromoscopia virtual com sistema de imagem multibanda poderia auxiliar no diagnóstico in vivo de neoplasias colônicas. Objetivo - Avaliar a exatidão da magnificação associada à cromoendoscopia eletrônica ou com índigo-carmin na distinção entre lesões neoplásicas e não-neoplásicas do cólon e reto. MÉTODOS: Foram avaliadas prospectivamente 157 lesões colorretais em 75 pacientes. Empregou-se o sistema FICE® para a análise dos padrões de capilares, com a malha capilar negativa sendo considerada padrão de lesões não-neoplásicas, e a malha capilar positiva, o padrão das neoplasias. Após esta avaliação, ainda usando o sistema FICE®, o padrão de criptas foi definido conforme a classificação de Kudo. Por fim, instilou-se índigo-carmin à 0,8% e outro estudo das criptas foi realizado. RESULTADOS: Entre as 157 lesões colorretais, classificou-se 116 como malha capilar positiva, sendo 115 confirmadas histologicamente como neoplasias. Já entre as 41 lesões com malha capilar negat...
GE - Portuguese Journal of Gastroenterology
Introduction: Imaging diagnosis of pancreatic solid-pseudopapillary neoplasms (SPNs) is difficult... more Introduction: Imaging diagnosis of pancreatic solid-pseudopapillary neoplasms (SPNs) is difficult. Preoperative diagnosis by endosonography-guided fine-needle aspiration (EUS-FNA) is possible and has been reported in the literature in pancreatic tumors. However, its usefulness is still controversial. The aim of this study was to determine the accuracy of the EUS-FNA in the diagnosis of patients with SPN and describe the findings in computerized tomography (CT), magnetic resonance cholangiopancreatography imaging (MRI/MRCP), and EUS therefore comparing the imaging methods alone to the findings of microhistology (McH) obtained by EUS-FNA. Materials and Methods: We retrospectively reviewed the medical records of patients undergoing EUS-FNA with suspected SPN in imaging studies in 5 Brazilian high-volume hospitals (two university hospitals and three private hospitals). The demographic data; findings in CT, MRI/MRCP, and EUS; and McH results obtained by EUS-FNA were noted prospectively. ...
A acalasia e um disturbio da motilidade esofagica caracterizado por um relaxamento inadequado do ... more A acalasia e um disturbio da motilidade esofagica caracterizado por um relaxamento inadequado do esfincter esofagico inferior a degluticao. A disfagia e o sintoma predominante da doenca, e as principais opcoes terapeuticas para sua resolucao sao a dilatacao endoscopica e a miotomia cirurgica, procedimentos invasivos nao isentos de riscos. Recentemente a injecao no esfincter inferior do esofago de toxina botulinica por meio de endoscopia foi reconhecida como metodo seguro e eficaz no alivio da disfagia provocada pela acalasia. A oportunidade que tivemos de tratar tres casos com esse metodo, com resolucao da disfagia em todos eles, motivou o presente estudo
Endoscopy, Oct 25, 2017
Video 1 Adenosquamous carcinoma is an aggressive subtype of adenocarcinoma, accounting for less t... more Video 1 Adenosquamous carcinoma is an aggressive subtype of adenocarcinoma, accounting for less than 4 % of all exocrine pancreatic malignancies. Endoscopic ultrasoundguided fine-needle aspiration can guarantee the diagnosis in the presence of a ductal adenocarcinoma mixed with malignant squamous cell carcinoma and specific immunohistochemical markers. Lopes César Vivian et al. Pancreatic adenosquamous carcinoma confirmed by EUS-FNA … Endoscopy 2018; 50: E13-E14 E13 This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Arquivos de gastroenterologia
Barrett's esophagus is a well-known pre-malignant condition. Pathologic interpretation of bio... more Barrett's esophagus is a well-known pre-malignant condition. Pathologic interpretation of biopsy specimens guides endoscopic surveillance as well as the therapeutic approach that will be carried out. However, the predictive value of histopathologic diagnosis can be questioned due to its poor intra- and interobserver reproducibility. To assess intra- and interobserver variability in the diagnosis of Barrett's dysplasia. Three-micrometer thick sections from biopsy specimens from 42 patients with Barrett's esophagus were stained with hematoxylin-eosin and PAS-alcian blue. The reading of the slides was carried out blindly in a light microscope. Intra and interobserver variability in the interpretation of the slides was determined by kappa statistics. The number of tissue specimens was 229, with average of 5.45 (1 to 18) fragments for patient. Low grade dysplasia was diagnosed by pathologists in 21.4% to 52.4% of the cases. The intra-observer agreement for the diagnosis of lo...
World Journal of Gastroenterology
Pancreatic cystic lesions (PCLs) have been increasingly recognized in clinical practice. Although... more Pancreatic cystic lesions (PCLs) have been increasingly recognized in clinical practice. Although inflammatory cysts (pseudocysts) are the most common PCLs detected by cross-sectional imaging modalities in symptomatic patients in a setting of acute or chronic pancreatitis, incidental pancreatic cysts with no symptoms or history of pancreatitis are usually neoplastic cysts. For these lesions, it is imperative to identify mucinous cysts (intraductal papillary mucinous neoplasms and mucinous cystic neoplasms) due to the risk of their progression to malignancy. However, no single imaging modality alone is sufficient for a definitive diagnosis of all PCLs. The cyst fluid obtained by endoscopic ultrasound-guided fine needle aspiration provides additional information for the differential diagnosis of PCLs. Current recommendations suggest sending cyst fluid for cytology evaluation and measurement of carcinoembryonic antigen (CEA) levels. Unfortunately, the sensitivity of cytology is greatly limited, and cyst fluid CEA has demonstrated insufficient accuracy as a predictor of mucinous cysts. More recently, cyst fluid glucose has emerged as an alternative to CEA for distinguishing between mucinous and nonmucinous lesions. Herein, the clinical utility of cyst fluid glucose and CEA for the differential diagnosis of PCLs was evaluated.
World journal of gastrointestinal endoscopy, Jan 16, 2018
To investigate the success rates of endosonography (EUS)-guided biliary drainage (EUS-BD) techniq... more To investigate the success rates of endosonography (EUS)-guided biliary drainage (EUS-BD) techniques after endoscopic retrograde cholangiopancreatography (ERCP) failure for management of biliary obstruction. From Feb/2010 to Dec/2016, ERCP was performed in 3538 patients, 24 of whom (0.68%) suffered failure to cannulate the biliary tree. All of these patients were initially submitted to EUS-guided rendez-vous (EUS-RV) by means of a transhepatic approach. In case of failure, the next approach was an EUS-guided anterograde stent insertion (EUS-ASI) or an EUS-guided hepaticogastrostomy (EUS-HG). If a transhepatic approach was not possible or a guidewire could not be passed through the papilla, EUS-guided choledochoduodenostomy (EUS-CD) was performed. Patients were submitted to EUS-RV (7), EUS-ASI (5), EUS-HG (6), and EUS-CD (6). Success rates did not differ among the various EUS-BD techniques. Overall, technical and clinical success rates were 83.3% and 75%, respectively. Technical succ...
Endoscopic ultrasound
At the time of its introduction in the early 80s, endoscopic ultrasonography (EUS) was indicated ... more At the time of its introduction in the early 80s, endoscopic ultrasonography (EUS) was indicated for diagnostic purposes. Recently, EUS has been employed to assist or to be the main platform of complex therapeutic interventions. From a series of relevant new topics in the literature and based on the need to complement the I Brazilian consensus on EUS, twenty experienced endosonographers identified and reviewed the pertinent literature in databases. The quality of evidence, strength of recommendations, and level of consensus were graded and voted on. Consensus was reached for eight relevant topics: treatment of gastric varices, staging of nonsmall cell lung cancer, biliary drainage, tissue sampling of subepithelial lesions (SELs), treatment of pancreatic fluid collections, tissue sampling of pancreatic solid lesions, celiac neurolysis, and evaluation of the incidental pancreatic cysts. There is a high level of evidence for staging of nonsmall cell lung cancer; biopsy of SELs as the s...
Journal of the Pancreas, 2018
Purpose Imaging diagnosis of SPN is difficult. Preoperative diagnosis by EUS-FNA) is possible, sa... more Purpose Imaging diagnosis of SPN is difficult. Preoperative diagnosis by EUS-FNA) is possible, safe, and has been reported in the literature. However, its usefulness is still controversial. The aim of this study was to determine the accuracy of the EUS-FNA and imaging findings in CT and MRI/MRCP exams in the diagnosis of patients with SPN. Methods We retrospectively reviewed the medical records of patients undergoing EUS-FNA with suspected diagnosis of SPN on imaging studies in 5 high-volume hospitals. The final diagnosis was obtained after the histological examination of the surgical specimen. Demographic data, CT, MRI and EUS findings, anatomopathological specimen and McH results obtained by EUS were analyzed. Results Fifty-four patients were included, of which 49 (90.7%) were women with an average age of 33.4 (range 11–78) years. The most common symptom presented was abdominal pain, present in 35.2%. SPN was detected incidentally in 32 (59%). The mean size of the tumors was 3.8 c...
Supportive Oncology, 2011
World Journal of Gastroenterology, 2008
ABCD, Jun 21, 2018
Background: Tissue diagnosis is required for gastric subepithelial lesions for differential diagn... more Background: Tissue diagnosis is required for gastric subepithelial lesions for differential diagnosis of GISTs. However, there has not been consensus about the best needle for EUS-guided sampling of these lesions. Aim: To evaluate the diagnostic yield of EUS-FNA for gastric subepithelial lesions of the proper muscle layer with large-bore 19 gauge needles. Methods: A prospectively maintained database was retrospectively reviewed to identify consecutive patients who underwent EUS-FNA with 19 and 22 gauge needles for gastric subepithelial lesions of the fourth endosonographic layer in a tertiary care referral center. EUS-FNA was performed by the same endosonographer, using the fanning technique, without on-site cytopathologist. Specimens were analysed through cell blocks by the same pathologist. Procedure results were categorized into diagnostic, defined as enough material for histopathology and immunohistochemistry, or nondiagnostic. Results: Eighty-nine patients (mean age: 59 years, 77% women) underwent 92 EUS-FNA with 19 (75) or 22 (17) gauge needles. Mean lesion size was 22.6 mm. Overall diagnostic yield was 88%. The diagnostic yield of 19 gauge was higher than that of 22 gauge needle (92%x70.6%; p=0.0410), and similar for lesions >2 cm and <2 cm (93.7%x90.7%; p=0.9563). The best performance for 19 gauge needles was obtained performing <3 needle passes. Complication rate was 2.8%. Conclusions: Diagnostic yield of EUS-FNA with 19 gauge needles is 92% for gastric subepithelial lesions of the proper muscle layer. It is safe and highly valuable for differentiation between GIST and leiomyoma, no matter the size of the lesion.
Endoscopic ultrasound, Jan 6, 2017
Arquivos de Gastroenterologia, 2013
ContextPancreatic splenosis is a benign condition which can mimic a pancreatic neoplasm.Objective... more ContextPancreatic splenosis is a benign condition which can mimic a pancreatic neoplasm.ObjectiveTo describe the role of the endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic nodules suspicious for pancreatic splenosis.MethodFrom 1997 to 2011, patients with pancreatic solid tumors suspicious for splenosis by computed tomography and/or magnetic resonance imaging were referred to EUS-FNA. Those cases with pancreatic splenosis confirmed by EUS-FNA or surgery were included. Endosonographic findings and clinicopathologic features were also analysed.ResultsA total of 2,060 patients with pancreatic solid tumors underwent EUS-FNA. Fourteen (0.6%) cases with pancreatic splenosis were found. After applying exclusion criteria, 11 patients were selected. Most patients were male (7), young (mean age: 42 years) and asymptomatic (8). Endoscopic ultrasound imaging alone suspected pancreatic splenosis in 6 cases, and neuroendocrine tumors in 5 cases. Pancreatic splenosis wa...
Arquivos de Gastroenterologia, 2014
Context The size of colorectal lesions, besides a risk factor for malignancy, is a predictor for ... more Context The size of colorectal lesions, besides a risk factor for malignancy, is a predictor for deeper invasion Objectives To evaluate the malignancy of colorectal lesions ≥20 mm. Methods Between 2007 and 2011, 76 neoplasms ≥20 mm in 70 patients were analyzed Results The mean age of the patients was 67.4 years, and 41 were women. Mean lesion size was 24.7 mm ± 6.2 mm (range: 20 to 50 mm). Half of the neoplasms were polypoid and the other half were non-polypoid. Forty-two (55.3%) lesions were located in the left colon, and 34 in the right colon. There was a high prevalence of III L (39.5%) and IV (53.9%) pit patterns. There were 72 adenomas and 4 adenocarcinomas. Malignancy was observed in 5.3% of the lesions. Thirty-three lesions presented advanced histology (adenomas with high-grade dysplasia or early adenocarcinoma), with no difference in morphology and site. Only one lesion (1.3%) invaded the submucosa. Lesions larger than 30 mm had advanced histology (P = 0.001). The primary tr...
An increased frequency of digestive hemorrhage from nonvariceal sources is descri- bed after vari... more An increased frequency of digestive hemorrhage from nonvariceal sources is descri- bed after variceal ligation. The aim of this study is to verify the impact of the eradication of esophageal varices by endoscopic ligation on the portal pressure gradient. Twenty-two cirrhotics (15M/7F, mean age: 54.5 years) with previous variceal bleeding were submit- ted to measurement of hepatic venous pressure gradient before and after variceal eradi- cation by endoscopic ligation. The mean hepatic venous pressure gradient in the first measurement was 14.1mmHg and after eradication, 13.5mmHg (p=0.403). After eradica- tion, 12 patients experienced a reduction in portal pressure and 10, an elevation. We conclude that esophageal variceal eradication by endoscopic band ligation does not alter the hepatic venous pressure gradient.
Arquivos de Gastroenterologia, 2009
CONTEXTO: O uso da cromoscopia virtual com sistema de imagem multibanda poderia auxiliar no diagn... more CONTEXTO: O uso da cromoscopia virtual com sistema de imagem multibanda poderia auxiliar no diagnóstico in vivo de neoplasias colônicas. Objetivo - Avaliar a exatidão da magnificação associada à cromoendoscopia eletrônica ou com índigo-carmin na distinção entre lesões neoplásicas e não-neoplásicas do cólon e reto. MÉTODOS: Foram avaliadas prospectivamente 157 lesões colorretais em 75 pacientes. Empregou-se o sistema FICE® para a análise dos padrões de capilares, com a malha capilar negativa sendo considerada padrão de lesões não-neoplásicas, e a malha capilar positiva, o padrão das neoplasias. Após esta avaliação, ainda usando o sistema FICE®, o padrão de criptas foi definido conforme a classificação de Kudo. Por fim, instilou-se índigo-carmin à 0,8% e outro estudo das criptas foi realizado. RESULTADOS: Entre as 157 lesões colorretais, classificou-se 116 como malha capilar positiva, sendo 115 confirmadas histologicamente como neoplasias. Já entre as 41 lesões com malha capilar negat...
GE - Portuguese Journal of Gastroenterology
Introduction: Imaging diagnosis of pancreatic solid-pseudopapillary neoplasms (SPNs) is difficult... more Introduction: Imaging diagnosis of pancreatic solid-pseudopapillary neoplasms (SPNs) is difficult. Preoperative diagnosis by endosonography-guided fine-needle aspiration (EUS-FNA) is possible and has been reported in the literature in pancreatic tumors. However, its usefulness is still controversial. The aim of this study was to determine the accuracy of the EUS-FNA in the diagnosis of patients with SPN and describe the findings in computerized tomography (CT), magnetic resonance cholangiopancreatography imaging (MRI/MRCP), and EUS therefore comparing the imaging methods alone to the findings of microhistology (McH) obtained by EUS-FNA. Materials and Methods: We retrospectively reviewed the medical records of patients undergoing EUS-FNA with suspected SPN in imaging studies in 5 Brazilian high-volume hospitals (two university hospitals and three private hospitals). The demographic data; findings in CT, MRI/MRCP, and EUS; and McH results obtained by EUS-FNA were noted prospectively. ...
A acalasia e um disturbio da motilidade esofagica caracterizado por um relaxamento inadequado do ... more A acalasia e um disturbio da motilidade esofagica caracterizado por um relaxamento inadequado do esfincter esofagico inferior a degluticao. A disfagia e o sintoma predominante da doenca, e as principais opcoes terapeuticas para sua resolucao sao a dilatacao endoscopica e a miotomia cirurgica, procedimentos invasivos nao isentos de riscos. Recentemente a injecao no esfincter inferior do esofago de toxina botulinica por meio de endoscopia foi reconhecida como metodo seguro e eficaz no alivio da disfagia provocada pela acalasia. A oportunidade que tivemos de tratar tres casos com esse metodo, com resolucao da disfagia em todos eles, motivou o presente estudo
Endoscopy, Oct 25, 2017
Video 1 Adenosquamous carcinoma is an aggressive subtype of adenocarcinoma, accounting for less t... more Video 1 Adenosquamous carcinoma is an aggressive subtype of adenocarcinoma, accounting for less than 4 % of all exocrine pancreatic malignancies. Endoscopic ultrasoundguided fine-needle aspiration can guarantee the diagnosis in the presence of a ductal adenocarcinoma mixed with malignant squamous cell carcinoma and specific immunohistochemical markers. Lopes César Vivian et al. Pancreatic adenosquamous carcinoma confirmed by EUS-FNA … Endoscopy 2018; 50: E13-E14 E13 This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.
Arquivos de gastroenterologia
Barrett's esophagus is a well-known pre-malignant condition. Pathologic interpretation of bio... more Barrett's esophagus is a well-known pre-malignant condition. Pathologic interpretation of biopsy specimens guides endoscopic surveillance as well as the therapeutic approach that will be carried out. However, the predictive value of histopathologic diagnosis can be questioned due to its poor intra- and interobserver reproducibility. To assess intra- and interobserver variability in the diagnosis of Barrett's dysplasia. Three-micrometer thick sections from biopsy specimens from 42 patients with Barrett's esophagus were stained with hematoxylin-eosin and PAS-alcian blue. The reading of the slides was carried out blindly in a light microscope. Intra and interobserver variability in the interpretation of the slides was determined by kappa statistics. The number of tissue specimens was 229, with average of 5.45 (1 to 18) fragments for patient. Low grade dysplasia was diagnosed by pathologists in 21.4% to 52.4% of the cases. The intra-observer agreement for the diagnosis of lo...
World Journal of Gastroenterology
Pancreatic cystic lesions (PCLs) have been increasingly recognized in clinical practice. Although... more Pancreatic cystic lesions (PCLs) have been increasingly recognized in clinical practice. Although inflammatory cysts (pseudocysts) are the most common PCLs detected by cross-sectional imaging modalities in symptomatic patients in a setting of acute or chronic pancreatitis, incidental pancreatic cysts with no symptoms or history of pancreatitis are usually neoplastic cysts. For these lesions, it is imperative to identify mucinous cysts (intraductal papillary mucinous neoplasms and mucinous cystic neoplasms) due to the risk of their progression to malignancy. However, no single imaging modality alone is sufficient for a definitive diagnosis of all PCLs. The cyst fluid obtained by endoscopic ultrasound-guided fine needle aspiration provides additional information for the differential diagnosis of PCLs. Current recommendations suggest sending cyst fluid for cytology evaluation and measurement of carcinoembryonic antigen (CEA) levels. Unfortunately, the sensitivity of cytology is greatly limited, and cyst fluid CEA has demonstrated insufficient accuracy as a predictor of mucinous cysts. More recently, cyst fluid glucose has emerged as an alternative to CEA for distinguishing between mucinous and nonmucinous lesions. Herein, the clinical utility of cyst fluid glucose and CEA for the differential diagnosis of PCLs was evaluated.
World journal of gastrointestinal endoscopy, Jan 16, 2018
To investigate the success rates of endosonography (EUS)-guided biliary drainage (EUS-BD) techniq... more To investigate the success rates of endosonography (EUS)-guided biliary drainage (EUS-BD) techniques after endoscopic retrograde cholangiopancreatography (ERCP) failure for management of biliary obstruction. From Feb/2010 to Dec/2016, ERCP was performed in 3538 patients, 24 of whom (0.68%) suffered failure to cannulate the biliary tree. All of these patients were initially submitted to EUS-guided rendez-vous (EUS-RV) by means of a transhepatic approach. In case of failure, the next approach was an EUS-guided anterograde stent insertion (EUS-ASI) or an EUS-guided hepaticogastrostomy (EUS-HG). If a transhepatic approach was not possible or a guidewire could not be passed through the papilla, EUS-guided choledochoduodenostomy (EUS-CD) was performed. Patients were submitted to EUS-RV (7), EUS-ASI (5), EUS-HG (6), and EUS-CD (6). Success rates did not differ among the various EUS-BD techniques. Overall, technical and clinical success rates were 83.3% and 75%, respectively. Technical succ...
Endoscopic ultrasound
At the time of its introduction in the early 80s, endoscopic ultrasonography (EUS) was indicated ... more At the time of its introduction in the early 80s, endoscopic ultrasonography (EUS) was indicated for diagnostic purposes. Recently, EUS has been employed to assist or to be the main platform of complex therapeutic interventions. From a series of relevant new topics in the literature and based on the need to complement the I Brazilian consensus on EUS, twenty experienced endosonographers identified and reviewed the pertinent literature in databases. The quality of evidence, strength of recommendations, and level of consensus were graded and voted on. Consensus was reached for eight relevant topics: treatment of gastric varices, staging of nonsmall cell lung cancer, biliary drainage, tissue sampling of subepithelial lesions (SELs), treatment of pancreatic fluid collections, tissue sampling of pancreatic solid lesions, celiac neurolysis, and evaluation of the incidental pancreatic cysts. There is a high level of evidence for staging of nonsmall cell lung cancer; biopsy of SELs as the s...