Best practice & research. Clinical gastroenterology
-
Best Pract Res Clin Gastroenterol · Jan 2009
ReviewEndoscopic ultrasound-guided fine-needle aspiration biopsy and trucut biopsy in gastroenterology - An overview.
Endoscopic ultrasound (EUS)-guided biopsies are reliable, safe and effective techniques in obtaining samples for cytological or histological examinations either as a primary procedure or in cases where other biopsy techniques have failed. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA), as well as endoscopic ultrasound-guided trucut biopsy (EUS-TCB), has proven to be of significant value in the diagnostic evaluation of benign and malignant diseases, as well as in staging of the malignant tumours of the gastrointestinal tract and of adjacent organs. The diagnostic yield of EUS-guided biopsies depends on site, size and characteristics of target tissues as well as technical and procedural factors (type of needle, biopsy technique and material processing). ⋯ There are numerous challenges and pitfalls in the differential diagnostic classification of benign and malignant lesions. These problems are related to the characteristics of samples obtained by EUS-guided biopsy, as well as to the multiple diagnoses with similar or overlapping cytological or histological characteristics. The high prognostic and therapeutic relevance of the cytopathological diagnoses resulting from EUS-guided biopsy calls for a shared responsibility of an endosonographer and a cytopathologist.
-
Coeliac plexus neurolysis (CPN) has been performed for nearly 100 years to try and control pancreatic pain. In recent years endoscopic ultrasound (EUS)-guided CPN has become the preferred technique for this procedure yet relatively little data exists to support its superiority over other methods. Recent studies have demonstrated the potential for direct EUS-guided injection into coeliac ganglia as a means to improve efficacy of CPN. This article describes the technique of EUS-CPN, the evidence supporting its use and recent advances in this procedure.
-
Pancreatic neuroendocrine tumours are rare tumours ( approximately 1/100,00 population/year) of which 60% are non-functioning. Except for insulinoma all types are malignant in >50% of cases. In multiple endocrine neoplasia (MEN)1, pancreatic neuroendocrine tumours occur in 40-80% of patients and are mostly non-functioning tumours or gastrinomas. ⋯ The local treatment for liver metastases is now well established and options include liver resection, chemoembolisation and radiofrequency ablation. Systemic therapies have also been better defined and include radionuclide therapy against somatostatin receptors or MIBG and chemotherapy especially for poorly differentiated tumours. A number of novel agents are currently in clinical development.
-
Sedation for endoscopy provides comfort for the patient and better examination conditions for the endoscopist. The high costs of providing anaesthesia by specialists and the relative lack of specialist personnel in many countries have led to the wider introduction of sedation delivered by non-anaesthesiologists. ⋯ Several conditions have to be fulfilled to provide proper and safe non-anaesthesiologist sedation for endoscopy, especially when propofol is to be used. These conditions include formal training, supervision by anaesthesiology staff, and definition of standard operating procedures on the national as well as local levels.