Sanjay Sikka

Comparison of white light and narrow band high definition images in predicting colon polyp histology, using standard colonoscopes without optical magnification.

BACKGROUND AND STUDY AIMS Narrow band imaging (NBI) with optical magnification is useful in predicting colon polyp histology. As magnifying endoscopes are not routinely available, we investigated the use of NBI and high definition white light imaging in determining polyp histology, using images obtained with colonoscopes without optical magnification. PATIENTS AND METHODS Images (white light and NBI) of colon polyps less than 10 mm in diameter were collected prospectively from patients undergoing screening colonoscopy and digitally stored. Two endoscopists later reviewed all images and predicted polyp histology as neoplastic or non-neoplastic using a modified Kudo classification. Comparison was made with histopathology. RESULTS Separate white light and NBI images of 80 polyps (49 neoplastic, 31 non-neoplastic) from 63 patients were recorded. Mean polyp size was 5.1 +/- 2.1 mm (5.4 +/- 2.2 neoplastic; 4.4 +/- 1.8 non-neoplastic; P = 0.02). In a pooled analysis, NBI correctly predicted neoplastic histology in 93 of 98 images (sensitivity 95 %, positive predictive value [PPV] 94 %) whereas white light did so in 58 of 98 images (sensitivity 59 %, PPV 79 %). NBI correctly predicted non-neoplastic histology in 56 of 62 images (specificity 90 %, negative predictive value [NPV] 92 %) whereas white light did so in 47 of 62 images (specificity 76 %, NPV 54 %). CONCLUSIONS NBI without optical magnification was more accurate in predicting colon polyp histology compared with white light imaging. Image quality and confidence in histology were significantly higher in the NBI group. NBI without optical magnification may be useful in predicting colon polyp histology.

EUS-guided drainage of hepatic abscess

macroscopic type; as the polyp grows larger and becomes semipedunculated or pedunculated, adenomatous or dysplastic foci appear first, followed by the cancerous lesion. Most adenocarcinomas found within HPs are well differentiated. The occurrence of poorly differentiated adenocarcinoma in an HP is rare. The typical hyperplastic morphology of HP, characterized by ‘‘sawtooth’’ glands and no detectable dysplasia, usually is seen predominantly at the surface. Therefore, biopsy specimens from these polyps may not reveal underlying adenomatous tissue or cancer. The association of cancer and HP is not as clearly established as is the case with adenoma. Nevertheless, we believe and recommend, on the basis of available data that demonstrate that most cases of carcinoma in HP occur in larger polyps, that all gastric HPs larger than 1 cm be resected endoscopically in toto.

Pancreatitis is frequent among patients with side-branch intraductal papillary mucinous neoplasia diagnosed by EUS

BACKGROUND Because of greater recognition and improved imaging capabilities, intraductal papillary mucinous neoplasms (IPMNs) are being diagnosed with increasing frequency. IPMNs of the main pancreatic duct cause symptoms and lead to pancreatitis. Side-branch (SB) IPMNs are thought to cause symptoms less frequently, and their association with pancreatitis is not well defined. OBJECTIVE Our purpose was to ascertain whether an association exists between SB-IPMN and pancreatitis. DESIGN Single-center, retrospective study. SETTING Academic medical center. PATIENTS A total of 305 patients underwent EUS examinations between October 2002 and October 2006 for pancreatic cystic lesions. MAIN OUTCOME MEASUREMENT The main outcome measure was the frequency of acute or chronic pancreatitis that was not procedurally related. RESULTS Thirty-two patients had SB-IPMNs, and 11 (34%) had pancreatitis. Three patients reported a single episode, and 8 patients reported having recurrent episodes of pancreatitis. Overall, 17 (53%) patients had symptoms possibly attributable to SB-IPMN. Female sex (73% vs 38%) and multiple pancreatic lesions (54% vs 24%) were more commonly seen in those with pancreatitis, but were not statistically significant factors. Larger cyst size or cyst fluid marker levels did not appear associated with pancreatitis occurrence. EUS-FNA demonstrated communication with the pancreatic duct in 94% and thick, mucinous fluid in 84%. LIMITATIONS Single-center, retrospective study. CONCLUSIONS Pancreatitis was frequently associated with the presence of SB-IPMNs in our referral practice. SB-IPMNs should be considered in the differential diagnosis of patients with recurrent pancreatitis with cystic lesions seen on imaging studies. EUS-FNA was the most useful modality in helping to differentiate SB-IPMNs from other lesions.