EUS in patients with surgically altered upper GI anatomy - 24/08/11
Reprint requests: Dr Joseph Romagnuolo, MUSC GI and Hepatology, 25 Courtenay Drive, ART 7100, MSC 290, Charleston, SC 29425Résumé |
Background |
Information regarding the safety and feasibility of EUS-guided FNA (EUS/FNA) in surgically altered anatomy is limited.
Objective |
The aim of this study was to describe EUS outcomes for Billroth I and II, Whipple, Puestow, Roux-en-Y (including gastric bypass), esophagectomy, and Nissen fundoplication surgeries.
Design |
Retrospective study.
Setting |
Single tertiary-care center.
Patients |
This study involved 188 EUS procedures performed in patients with surgically altered anatomy by 6 endosonographers from July 1995 to October 2008.
Intervention |
EUS and FNA.
Main Outcome Measurements |
Type of surgery, EUS indication, limitations to imaging, reasons for limitations, FNA results, and EUS/FNA complications.
Results |
Of 188 patients, 96 were men (mean age 57 years; range, 16-92 years). Of patients with Billroth II anatomy (n = 39), 10 had limited (common bile duct [CBD], head of pancreas [HOP]) imaging because intubation of the afferent limb failed (n = 6) or was not attempted (n = 4). Roux-en-Y (n = 18) encompased a variety of surgeries, but in general (n = 13) the proximal duodenum was not reached and the HOP and CBD were not imaged. For Roux-en-Y gastric bypass (n = 7), the HOP and CBD were not imaged, with the exception of 1 case (in which staple-line dehiscence permitted access to the proximal duodenum). For the remaining procedures, EUS and FNA were successful with few exceptions. There were no significant adverse events (95% confidence interval, 0% to 1.9%).
Limitations |
Retrospective descriptive study.
Conclusion |
EUS is generally successful and safe in patients with surgically altered anatomy in this tertiary-care setting, and a very low rate of adverse events is possible. Exceptions included imaging the HOP and CBD after Roux-en-Y surgery. After Billroth II surgery, if the afferent limb was intubated, the majority of patients were able to have a complete pancreaticobiliary examination, including FNA.
Le texte complet de cet article est disponible en PDF.Abbreviations : CBD, HOP
Plan
| DISCLOSURE: R. Hawes disclosed that he is a consultant to and has received honoraria from Olympus America, that he is on an advisory committee of Boston Scientific, and that he has stock/ownership in Apollo Endosurgery. J. Romagnuolo disclosed that he is a consultant for and has received honoraria from Olympus America and Cook Endoscopy. No other financial relationships relevant to this publication were disclosed. |
Vol 72 - N° 5
P. 947-953 - novembre 2010 Retour au numéro
Article précédent
- Remote magnetic control of a wireless capsule endoscope in the esophagus is safe and feasible: results of a randomized, clinical trial in healthy volunteers
- Jutta Keller, Christiane Fibbe, Frank Volke, Jeremy Gerber, Alexander C. Mosse, Meike Reimann-Zawadzki, Elisha Rabinovitz, Peter Layer, Paul Swain
- Endoscopic management and outcomes of pregnant women hospitalized for nonvariceal upper GI bleeding: a nationwide analysis
- Geoffrey C. Nguyen, Amreen M. Dinani, Kevin Pivovarov
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?