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RISS 인기검색어
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- 저자 : Poneros (검색결과 3 건)
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Lalitha M. Sitaraman,Amit H. Sachdev,Tamas A. Gonda,Amrita Sethi,John M. Poneros,Frank G. Gress 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.2
Background/Aims: The aim of this study was to describe the diagnostic yield of endoscopic ultrasound (EUS) in patients with isolatedelevated levels of amylase and/or lipase. Methods: A retrospective chart review was conducted at a large academic medical center from 2000 to 2016. Patients were selectedbased on having elevated amylase, lipase, or both, but without a diagnosis of pancreatitis or known pancreatobiliary disease. Patientswere excluded if they had abnormal liver function tests or abnormal imaging of the pancreas. Results: Of 299 EUS procedures performed, 38 met inclusion criteria. Symptoms were present in 31 patients, most frequentlyabdominal pain (87%). In 20 patients (53%), initial EUS most commonly found chronic pancreatitis (n=7; 18%), sludge (5; 13%), or newdiagnosis of pancreas divisum (3; 8%). In the asymptomatic patients (7), 3 had a finding on EUS, most importantly sludge (2), stone (1),and pancreas divisum (1). No patients were diagnosed with a mass or pancreatic cyst. During the follow up period, 6 patients (22%) hadcholecystectomy. Conclusions: In our study of patients with isolated elevations in amylase and/or lipase without acute pancreatitis who underwent EUS,approximately 50% had a pancreatobiliary finding, most commonly chronic pancreatitis or biliary sludge.
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Benjamin D. Renelus,Daniel S. Jamorabo,Iman Boston,William M. Briggs,John M. Poneros 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.2
Background/Aims: Studies comparing the utility of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) andendoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for solid pancreatic lesions have been inconclusive with no clearsuperiority. The aim of this meta-analysis was to compare the diagnostic accuracy and safety between the two sampling techniques. Methods: We performed a systematic search of randomized controlled trials published between 2012 and 2019. The primaryoutcome was overall diagnostic accuracy. Secondary outcomes included adverse event rates, cytopathologic and histopathologicaccuracy, and the mean number of passes required to obtain adequate tissue between FNA and FNB needles. Fixed and randomeffect models with pooled estimates of target outcomes were developed. Results: Eleven studies involving 1,365 participants were included for analysis. When compared to FNB, FNA had a significantreduction in diagnostic accuracy (81% and 87%, p=0.005). In addition, FNA provided reduced cytopathologic accuracy (82% and89%, p=0.04) and an increased number of mean passes required compared to FNB (2.3 and 1.6, respectively, p<0.0001). There wasno difference in adverse event rate between FNA and FNB needles (1.8% and 2.3% respectively, p=0.64). Conclusions: FNB provides superior diagnostic accuracy without compromising safety when compared to FNA. FNB should bereadily considered by endosonographers when evaluating solid pancreatic masses.
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YongYan Cui,Lauren G. Khanna,Anjali Saqi,John P. Crapanzano,James M. Mitchell,Amrita Sethi,Tamas A. Gonda,Michael D. Kluger,Beth A. Schrope,John Allendorf,John A. Chabot,John M. Poneros 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.2
Background/Aims: The management of small, incidentally discovered nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs)has been a matter of debate. Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is a tool used to identify and risk-stratifyPNETs. This study investigates the concordance rate of Ki67 grading between EUS-FNA and surgical pathology specimens in NF-PNETs and whether certain NF-PNET characteristics are associated with disease recurrence and disease-related death. Methods: We retrospectively reviewed the clinical history, imaging, endoscopic findings, and pathology records of 37 cases of NF-PNETs that underwent pre-operative EUS-FNA and surgical resection at a single academic medical center. Results: There was 73% concordance between Ki67 obtained from EUS-FNA cytology and surgical pathology specimens; concordancewas the highest for low- and high-grade NF-PNETs. High-grade Ki67 NF-PNETs based on cytology (p=0.028) and histology (p=0.028)were associated with disease recurrence and disease-related death. Additionally, tumors with high-grade mitotic rate (p=0.005), tumorsize >22.5 mm (p=0.104), and lymphovascular invasion (p=0.103) were more likely to have poor prognosis. Conclusions: NF-PNETs with high-grade Ki67 on EUS-FNA have poor prognosis despite surgical resection. NF-PNETs withintermediate-grade Ki67 on EUS-FNA should be strongly considered for surgical resection. NF-PNETs with low-grade Ki67 on EUS-FNA can be monitored without surgical intervention, up to tumor size 20 mm.
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