Grant R. Caddy

The accuracy of EUS-FNA in assessing mediastinal lymphadenopathy and staging patients with NSCLC

Optimal management of nonsmall cell lung cancer (NSCLC) depends on tissue diagnosis and accurate staging. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is minimally invasive and provides cytological confirmation of malignant mediastinal disease. The aim was to assess the accuracy of EUS-FNA in cases of enlarged mediastinal lymphadenopathy (LN) of unknown aetiology and in the staging of NSCLC. A total of 52 consecutive patients with stage I–IIIb NSCLC or enlarged mediastinal LN of unknown aetiology underwent EUS-FNA. Negative results were confirmed with a surgical procedure: mediastinoscopy, video-assisted thoracic surgery (VATS) or lobectomy with systematic mediastinal lymph node dissection. In total, 34 patients had EUS-FNA performed for diagnosis, whilst the remaining 18 had EUS-FNA for staging. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy (95% confidence interval) were 93% (77–99), 100% (78–100), 100% (87–100), 88% (63–99) and 95% (84–99), respectively. When EUS-FNA was used in patients with NSCLC, the sensitivity, specificity, PPV, NPV and accuracy were 92% (73–99), 100% (69–100), 100% (85–100), 83% (51–98) and 94% (80–99), respectively. For mediastinal LN of unknown aetiology, no malignant disease was missed. Endoscopic ultrasound-guided fine-needle aspiration is an accurate tool for assessing mediastinal lymph node involvement in nonsmall cell lung cancer and in the diagnosis of unexplained mediastinal lymphadenopathy. Endoscopic ultrasound-guided fine-needle aspiration is a minimally invasive procedure that can be used as an adjunct or alternative to mediastinoscopy.

Prospective study of the clinical impact of EUS

BACKGROUND Studies on the clinical impact of EUS are lacking. The aim of this study was to examine the impact of EUS on the management plans by referring doctors and patient outcomes. METHODS Consecutive patients undergoing EUS between August 2002 and June 2004 were prospectively studied. Referring doctors were given a pre-EUS questionnaire that asked about provisional diagnosis and management plan. A post-EUS questionnaire was sent 6 weeks after the procedure. RESULTS A total of 330 patients were examined, and completed questionnaires were received in 70%. EUS-guided FNA was performed in 69 (30%) patients. EUS resulted in a change in diagnosis and management in 26% and 48% of cases, respectively. Thirty-nine of the latter patients (33%) avoided unnecessary surgery. In 50% of cases, additional investigations were avoided. Doctors reported EUS as very or moderately useful in 210 patients (91%). Doctors of 223 patients (97%) reported that they would use EUS again. CONCLUSIONS The use of EUS had a significant clinical impact on patients. EUS resulted in a change of diagnosis in a fourth of patients and a change in management in half of patients studied.

CURRENT CLINICAL APPLICATIONS OF ENDOSCOPIC ULTRASOUND

Endoscopic ultrasound (EUS) has been developed since the early 1980s. Its clinical role in the diagnosis of gastrointestinal wall lesions and staging of gastrointestinal and lung cancer has evolved over the last two decades. Initially, it was either used as an imaging tool for gastrointestinal wall lesions or for staging of gastrointestinal tumours. However, in combination with fine‐needle aspiration under real‐time scanning, EUS is now being used in tissue sampling for diagnosis. In addition, EUS may be used therapeutically in coeliac plexus neurolysis or pseudocyst drainage. This review concentrates on the current applications of EUS.

Sa1150 What Do Young People and Parents Want From an Inflammatory Bowel Disease (IBD) Service

Introduction At present, there are guidelines from the US and Europe regarding the formation of transition clinics for adolescents with IBD. This includes a UK Inflammatory Bowel Disease (IBD) Standards guidance on optimal service provision for paediatric and adolescent care. However most of these guidelines come from intuitive reasoning and opinion, as there is a lack of data on what constitutes an ideal service for young patients with IBD. The aim of this study was to develop a comprehensive knowledge and understanding of the key service requirements of young people with IBD as well as their parents. Methods Paediatric and adolescent patients age 6–18 years, were identified from databases in two teaching hospitals and from the membership of the N Ireland branch of Crohn9s and Colitis UK, which is a patient support group. Anonymous questionnaires were sent to these patients and their parents separately. The questionnaires asked about their perceived quality of care, clinic care, general comments, input from specialists, support and information, plus any suggestions. Results 105 questionnaires were sent and 51 responded (49%); of these 21 were from patients and 30 from their parents. Over 84% were happy with the quality of care they are receiving. Reasons patients and parents were reluctant to attend clinics included: blood tests, nurse specialist or doctor not available, lack of car parking. 90% preferred to see the attending (Consultant) rather than a fellow. Nurse specialist, dietetics, specialist IBD surgeon, psychologist, skin/eye specialist input was thought to be beneficial by 95%, 81%, 71%, 59%, and 45% respectively. The following support service and information were considered important: immediate contact with healthcare personnel for disease flare, support groups for young adults, insurance and financial advice, knowledge about IBD developments and research, email service, surgical input regarding stomas. Conclusion The majority of young patients with IBD and their parents are satisfied with the care they are receiving. Support from specialist services such as nurse specialist, dietitians, specialist IBD surgeons, psychologist, plus rapid access to services when the disease flares were thought to be important by the patients and their parents. Knowledge of what these patients and their parents want will help to design an optimal IBD service. Competing interests R Little: None Declared, C Imrie Conflict with: Mead Johnson, Falk Pharma, Nutricia, Warner Chilcott, SHS, Norgine, Wyeth, A Derby: None declared, P Gillespie: None declared, G Caddy: None declared, T Tham Speaker bureau with: Warner Chilcott, Shire, Conflict with: Abbott, MSD.

7251 Natural history of asymptomatic bile duct stones at time of cholecystectomy.

OBJECTIVES: There is little data on the natural history of asymptomatic bile duct stones and hence there is uncertainty on the management of asymptomatic bile duct stones discovered incidentally at the time of laparoscopic cholecystectomy. We retrospectively reviewed a group of patients who had previously underwent laparoscopic cholecystectomy, but who did not have a pre-operative suspicion of intra-ductal stones, to determine if any biliary complications had subsequently developed. A group of patients who had no pre-operative suspicion of intra-ductal stones, but routinely underwent intraoperative cholangiogram (IOC) at time of cholecystectomy, served as the control group. METHODS: A telephone questionnaire was completed by each patients family practitioner in 59 of 79 (75%) patients who underwent laparoscopic cholecystectomy. In the remaining 20 patients additional information was obtained from hospital records and from the central services agency (CSA). These patients had no pre-operative suspicion of bile duct stones and therefore did not undergo an IOC or ERCP. The control group (73 patients) had no pre-operative suspicion of bile duct stones but had a routine IOC performed to define the biliary anatomy. RESULTS: 59 patients were followed up for an average of 57 months (range 30-78 months) after laparoscopic cholecystectomy. None of these patients developed pancreatitis, jaundice, deranged liver function tests (LFTs), or required ERCP or other biliary intervention. In the additional 20 patients where no information was available from the family practitioner, 11 patients had follow up appointments with no documentation of biliary complications or abnormal LFTs. 19 of 20 patients were traceable through the CSA and were all alive. Only 1 patient was untraceable and therefore unknown if biliary complications had developed. In the control group, 4 of 73 (6%) patients had intraductal stones detected and extracted. Thus the prevalence of asymptomatic bile duct stones during the time of cholecystectomy in our population was 6%. CONCLUSIONS: Asymptomatic bile duct stones discovered at the time of cholecystectomy do not appear to cause any biliary complications over a 5-year follow up. Incidental bile duct stones found in patients undergoing laparoscopic cholecystectomy may not need to be removed.