Abstracts

Results: The histological diagnosis was carcinoma (mean size 21.8 mm [7-50 mm])in 52 cases and adenoma in 6 cases. 1) Overall accuracy for local progression by EUSwas Du 75.9% and Panc 84.6%. Accuracy of T classification by EUS was 65.4% in thecarcinoma group. 2) In Group A, diagnostic accuracy for local progression and Tclassification without the soft baloon was Du 87.5%, Panc 75.0%, and Tclassification68.8%. In Group B, diagnostic accuracy without the soft baloon was Du 60.0%, Panc80.0%, and T classification 50.0%. 3) In Group B, diagnostic accuracy with the softbaloon was Du 67.7%, Panc 100%, and T classification 83.3%.Conclusion: EUS is a useful modality for diagnosing local progression and Tclassification of tumors of the ampulla, and the soft baloon is useful for diagnosis inthe patients with a small tumor and without using an antispastic agent.

Endo-sonographic prevalence of early chronic pancreatitis in

chronic alcoholicsBhagwan S. Thakur, Arvind Namdeo, Shohini Sircar, Gunjan G. Joshi,Somitra Pareek, Ajay K. JainBackground: Alcohol is among the commonest cause of chronic pancreatitis. EUSdetection of early chronic pancreatitis in asymptomatic alcoholics is an area ofactive research.Aim: To estimate the prevalence of early chronic pancreatitis in alcoholics withminimal or no abdominal symptoms.Methods: 19 pts with chronic excessive alcohol consumptions (O21 units/week formore than 5 years) were taken for EUS study to look for the changes in thepancreas based on established criteria for chronic pancreatitis from July 2007 to Feb2008. Each pt underwent thorough clinical, biochemical examination and USGabdomen to look for chronic liver disease and chronic pancreatitis. EUSexamination was done with radial array probe (GF-UM 130,Olympus). Changes ofchronic pancreatitis were defined as Normal 0-2, Early chronic pancreatitis 3-5Advanced chronic pancreatitis, O5.Results: Mean age was 42.36yrs .All patients were males. 5/19 (26.3%) pts hadunderlying chronic liver disease. Overall 6/19 (31.5.8%) had early chronicpancreatitis, 4/19 (21.05%) had advanced chronic pancreatitis and 9/19 (47.3%) ptshad normal pancreas.2/5 (40%) pts with chronic liver disease had associated earlychronic pancreatitis.Conclusion: One third pts with chronic alcohol consumption had early chronicpancreatitis. EUS prevalence of chronic pancreatitis in alcoholic liver disease may behigher than estimated by routine imaging.

EUS-guided drainage of pelvic abscessJessica Trevino, Shyam VaradarajuluBackground: Rupture of a pelvic abscess is a life threatening emergency.Unfortunately, not all patients are candidates for surgery or percutaneous drainplacement and require an alternate mode of drainage.Aim: Evaluate the role of EUS in management of pelvic abscesses which are notamenable for drainage by ultrasound/CT-guidance.Methods: Prospective study of poor-risk surgical patients who underwent EUS-guided drainage of pelvic abscesses that were not suitable for drainage byultrasound/CT-guidance due to lack of an adequate window. Followingadministration of prophylactic antibiotics, the pelvic abscess was first located usinga therapeutic echoendoscope. Subsequent to accessing the abscess cavity with a 19-gauge needle, a 0.035 inch guide wire was passed into the abscess cavity. Afterdilating the trans-mural tract, a 10-Fr trans-rectal drainage catheter was deployed.For abscesses that measured O9 cm, trans-rectal double pig-tail stents were placedin addition to the drainage catheter. Catheters were flushed periodically withnormal saline and discontinued when abscess resolution was documented onfollow-up CT. The stents were removed at follow-up endoscopy in 1 month.Technical success was defined as the ability to access and place catheter/stentwithin the abscess cavity. Treatment success was defined as the clinical resolution ofsymptoms and abscess on follow-up CT.Results: Of 12 patients referred for EUS, four were excluded due to presence ofa large rectocele (nZ1), multiloculated abscess (nZ1), peri-anal location (nZ1)and alternate diagnosis of pelvic cyst established at EUS-FNA (nZ1). The remaining8 patients (7men; mean age, 54 [range, 35-84]) underwent EUS-guided drainage.Etiology of abscess was post-surgical in 5 patients, diverticulitis in 1, ischemic in 1and infective endocarditis in 1. Abscess location was peri-rectal in 7 patients andperi-colonic (sigmoid) in one (25 cm above the dentate line). Mean size of theabscess was 83 mm x 63 mm. Only one of 8 abscesses caused luminal compressionvisible at endoscopy. Technical success was 100%. The treatment was successful in 7of 8 patients (87.5%): One patient undergoing treatment for heart failure died 48hrs following the procedure from pulmonary edema. The mean duration to abscessresolution was 3 days (range, 1-6 days). The mean procedural duration was 22minutes (range, 12-45). No procedure-related complications were encountered. Ata mean follow-up of 378 days (range, 65-575), all 7 patients reported completesymptom relief.Conclusions: EUS-guided trans-rectal drainage is a minimally invasive, safe, andeffective technique for management of pelvic abscesses that are within the reach ofthe echoendoscope.

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A case of malignant peritoneal mesothelioma diagnosed by

transcolonic EUS-FNATakayoshi TsuchiyaThe patient was an 83-year-old woman. She suffered abdominal discomfort aftermeals in September 2007. Abdominal CT showed ascites, and she was referred toour center in October 2007. Blood chemistry tests showed no abnormality. Oftumor markers, CEA and CA19-9 values were normal, CYFRA and IL2-R wereabnormally high (176.7ng/ml and 1153U/ml, respectively). Cytological resultsshowed class, non-atypical reactive mesothelial cells present in the ascites. AGastroscopy showed only a gastric ulcer scar. Abdominal CT revealed a mediumquantity of ascites, thickening of the wall of transverse colon and multiple tumorson the peritoneum. A Colonoscopy was performed, which revealed a hardsubmucosal tumor affecting the transverse colon nearly semi-circularly. For thepurpose of tissue diagnosis, we performed EUS-FNA. Firstly, a colonoscope wasinserted into the transverse colon, and then EUS scope was inserted via overtube.The EUS finding was a low-echoic mass, protruding from the wall of the transversecolon. FNA was performed with a 19G needle. Cytologically atypical cells with largenuclei and extended cytoplasm were diagnosed. Histological findings of H.E.-stainfound there were atypical cells with uneven distribution nuclei and irregularnucleus form. Immunohistochemistry-stain for tissue diagnosis showed cytokeratin5/6-positive, D2-40-positive, EMA-positive, calretinin-negative, p53-positive, CAM5.2-positive, CD20-negative, CD3-negative, CEA-negative, MOC-31-negative and TTF-1-negative. Therefor the final diagnosis was a malignant peritoneal mesothelioma.

EUS-guided transgastric drainage for omental bursa abscess

complicating appendicitis with diffuse peritonitisY. Uchiyama, H. Imazu, Y. Kawahara, S. Koyama, A. Kuramochi,S. Tsukinaga, H. Kakutani, H. Tajiri, S. OmarAim: Surgery is currently the mainstay of treatment for intra-abdominal abscess,although operative mortality is high. Percutaneous drainage is another option, butis associated with significant morbidity related to the relative long route used forcatheter placement. EUS-guided drainage is potentially safe and effective for intra-abdominal abscess. We report a case of omental bursa abscess complicatingappendicitis with diffuse peritonitis which was successfully and safely drained underEUS guidance.Method: A 28-year-old woman underwent appendectomy and surgical irrigationdrainage of Pouch of Douglas, left subphrenic space and right iliac fossa forappendicitis with diffuse peritonitis. Postoperatively after two weeks, patientcontinued to have high fever with elevated C-reactive protein. CT revealed a 5-cmomental bursa abscess adjacent to the stomach. A decision for EUS-guided drainagewas made to avoid a second open surgery. The abscess was visualized witha curvilinear echoendoscope (GF UC 2000P, Olympus Co., Tokyo, Japan) beforebeing punctured with a 19-gauge Echotip Ultra needle (Cook Endoscopy, Winston-Salem, NC, USA). A 480-cm-long, 0.035-inch guide wire (Cook Endoscopy) wasinserted into the abscess before the needle was removed, followed by placement ofa 7F naso-abscess Teflon catheter (Cook Endoscopy). A 5-cm-long 10F doublepigtail Teflon stent (Cook Endoscopy) was also inserted adjacent to the naso-abscess catheter to enable irrigation. There was no procedure-related complication.The catheter was removed after one week, when purulent material cease to drainfrom the catheter. The stent was removed 4 weeks later when CT showed completeabscess resolution. She was asymptomatic without any evidence of abscessrecurrence at two months follow-up after discharge.Conclusion: EUS-guided drainage of omental bursa abscess complicatingappendicitis with diffuse peritonitis is safe and effective and could be an alternativetherapy to surgery and percutaneous drainage.

The concept of bedside EUS: technology on the moveShyam Varadarajulu, Mohamad A. Eloubeidi, C. Mel WilcoxBackground: While the role of endoscopy for provision of emergent diagnosis andtherapy at bedside is well known, the concept of bedside EUS requires furthervalidation. Also, there are no prior reports on EUS-guided therapeutic interventionsperformed at patient bedside.Aim: Evaluate the concept of bedside EUS and assess its impact on patientmanagement.Methods: Prospective study of patients with pancreaticobiliary and thoracicdisorders who required EUS but were clinically unstable to be evaluated in theendoscopy suite. All procedures were performed by one endosonographer atpatient bedside using a mobile EUS cart that was equipped with a therapeuticcurvilinear echoendoscope. The main outcome measures were to evaluate the

olume 69, No. 2 : 2009 GASTROINTESTINAL ENDOSCOPY S259