Pancreatic metastases are very uncommon and originate most commonly from lung, colon, breast and kidney cancer. Ovarian adenocarcinoma has been reported as a primary site of pancreatic metastasis, but its diagnosis has rarely being reported by endoscopic ultrasound guided fine needle aspiration (EUS-FNA). We report a case of multiple metastases to the pancreas from ovarian carcinoma occurring four years after original resection of the primary tumour. Our patient presented with severe epigastric pain which was initially treated as acute pancreatitis. Further imaging modalities showed multiple large pseudocystic lesions in the pancreatic head and body. Subsequent EUS-FNA confirmed that the lesions were metastatic disease from an advanced ovarian carcinoma. She underwent palliative chemotherapy and the pancreatic lesion showed receding size.
Endoscopic ultrasound (EUS)-guided injection therapy is the new frontier in the management of patients with hepatobiliary disease. Celiac plexus block/neurolysis was the first form of injection therapy and has been validated in many subsequent trials. Cyst ablation therapy, fiducial insertion, angiography, portal hypertensive therapy, endoscopic portosystemic shunt creation, portal vein embolization and injection of chemotherapeutic/biologic agents for antitumor therapy are more recent uses and will be discussed. Celiac plexus neurolysis is currently well established in providing adjunct pain control in patients with advanced malignancy. There are limited data available for its use in benign conditions. EUS-guided ablative therapy for pancreatic cysts remains an area for future research but seems to have a role for small thin-walled non-septated cysts. EUS-guided implantation of fiducials is technically feasible but its exact impact on tumor regression is unknown. Several case reports have documented EUS-guided alcohol and thrombin injection into pseudoaneurysms and cyanoacrylate and coil embolization for variceal therapy. Injection of viral vectors and immunomodulating cell cultures as antitumor therapy has been described but the evidence is still preliminary and further data are awaited.
Solitary pulmonary nodule (SPN) always raises suspicion for early lung cancer, in which accurate and less invasive biopsy is needed. We report a case of transbronchial cryobiopsy of right upper lobe SPN under radial endobronchial ultrasound (R-EBUS) guidance after an inconclusive computed tomography guided transthoracic needle aspiration. A diagnosis of Stage 1B adenocarcinoma of the lung was made. Patient subsequently underwent curative right upper lobectomy after ruling out mediastinal lymph node involvement. To the best of our knowledge, this is the first report of R-EBUS guided transbronchial cryobiopsy case reported from Malaysia.
Since the publication of the Tokyo Guidelines in 2007 and their revision in 2013, appropriate management for acute cholecystitis has been more clearly established. Since the last revision, several manuscripts, especially for alternative endoscopic techniques, have been reported; therefore, additional evaluation and refinement of the 2013 Guidelines is required. We describe a standard drainage method for surgically high-risk patients with acute cholecystitis and the latest developed endoscopic gallbladder drainage techniques described in the updated Tokyo Guidelines 2018 (TG18). Our study confirmed that percutaneous transhepatic gallbladder drainage should be considered the first alternative to surgical intervention in surgically high-risk patients with acute cholecystitis. Also, endoscopic transpapillary gallbladder drainage or endoscopic ultrasound-guided gallbladder drainage can be considered in high-volume institutes by skilled endoscopists. In the endoscopic transpapillary approach, either endoscopic naso-gallbladder drainage or gallbladder stenting can be considered for gallbladder drainage. We also introduce special techniques and the latest outcomes of endoscopic ultrasound-guided gallbladder drainage studies. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
We report a case of a healthy 78-year-old indonesian man who presented with chronic weight loss, poor appetite and lethargy. CT abdomen showed bilateral adrenal masses. EUS-guided FNA was performed on the left adrenal gland. Histopathology report was Histoplasma Capsulatum. He recovered well with antifungal treatment without any complication. In this case, we found that the role of EUS -guided FNA was not only limited to diagnosis but also helped in the prognosis of the disease since the method was able to assess the general anatomy of the adrenal gland better than other imaging modalities due to its close proximity and direct visualization.