EUS-guided RFA in pancreatic diseases - EUS-ENDO › medias › files › EUS-ENDOcas2019.pdf ·...
Transcript of EUS-guided RFA in pancreatic diseases - EUS-ENDO › medias › files › EUS-ENDOcas2019.pdf ·...
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CLINICAL CASES
INSTITUT PAOLI-CALMETTES
EUS-ENDO 2019
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CASE N°1
Mrs MAE…., FEMALE, 72 YEARS OLD
JULY 2019: ABDOMINAL PAIN AFTER MEAL
GASTROSCOPY & COLONOSCOPY : NORMAL
AUGUST 2019: Ct SCAN SHOWED A DILATION OF THE MAIN PANCREATIC DUCT IN THE TAIL
SCHEDULED FOR EUS EVALUATION PANCREATIC MASS MISSED BY THE Ct SCAN ?
IPMN OF THE MAIN DUCT ?
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CASE N°2
Mr BIZ…, MALE , 67 YEARS OLD
SINCE JANUARY 2019, EPIGASTRIC PAIN , WEIGHT LOSS
Ct SCAN & MRI SHOWED A CHRONIC PANCREATITIS WITH CALCIFICATIONS
AUGUST 2019: PAIN INCREASE AND AN EUS IS PERFORMED
EUS SHOWED AN IMPACTED STONE IN THE MPD (ISTHMUS)
1 SESSION OF ESWL WAS PERFORMED WITH A FRAGMENTATION OF THE STONE
SCHEDULED FOR ERCP+PANCREATIC SPHINCTEROTOMY AND STONE EXTRACTION
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CASE N°3
Mrs BAR…., FEMALE, 48 YERAS OLD
JULY 2019 : SEVERE ACUTE PANCREATITIS OF UNKNOWN ORIGIN
AUGUST 2019: PANCREATIC PSEUDOCYST OF 60 MM OF DIAMETER
SEPTEMBER 2019: PERSISTANCE OF THE PSEUDOCYST WHICH INCREASE IN SIZE 100 X 70 MM
EUS SHOWED A PARTIALLY NECROTIC PSEUDOCYST AND MICRO STONES IN THE GALLBLADDER
SCHEDULED FOR EUS GUIDED DRAINAGE DISCUSSION PLASTIC STENT VS LAMS
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CASE N°4
Mrs PER…,FEMALE, 65 YEARS OLD
APRIL 2019 : Ct SCAN FOR THE FOLLOW-UP OF AN ANEUVRYSM OF THE ABDOMINAL AORTA SHOWED A PULMONARY LESION (LEFT LOBE)
Ct GUIDED BIOSPSY FOUND AN ADENOCARCINOMA AND A SURGERY WAS PERFORMED (LESION pT1N0M0)
AUGUST 2019: PET-SCAN SHOWED A PANCREATIC FIXATION
Ct AND MRI SHOWED A 12 MM LESION IN THE HEAD OF THE PANCREAS
SCHEDULED FOR AN EUS WITH FNA or FNB, ELASTOGRAPHY & SONOVUE
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CASE N°5
Mrs DOUV, FEMALE, 85 YEARS OLD
APRIL 2019 : JAUNDICE WITH DILATION OF THE CBD AND IHBD
EUS & MRI: CHOLANGIOCARCINOMA OF THE LOWER PART OF THE CBD OF 15X12 MM
PATIENT REFUSE THE SURGERY AND A BILIARY STENT WAS INSERTED
SEPTEMBER 2019: DUODENAL STENOSIS DUE TO AN INVOLVEMENT OF THE DUODENUM LUMEN
6/9/2019 : A DUODENAL STENT IS INSERTED
12/9/2019 : JAUNDICE RELAPSE
SCHEDULED FOR AN HEPATICO-GASTROSTOMY
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CASE N°6
Mrs DAD…,FEMALE, 90 YEARS OLD
AUGUST 2019: CHOLANGITIS DUE TO CDB STONES
26/8/2019 : ERCP SHOWED PERI-DIVERTICULAR PAPILLA
SPHINCTEROTOMY WAS PERFORMED BUT THE STONE WASN’T EXTRACTED
A PLASTIC STENT OF 9 CM/10F WAS INSERTED
SCHEDULED FOR STONE EXTRACTION OR SPY-GLASS LITHOTRIPSY
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CASE N°7
Mr KRAU…, MALE, 76 YEARS OLD
2016: 2 EPISODES OF MILD ACUTE PANCREATITIS
EUS & MRI : IPMN MIXTE TYPE
JUNE 2019: SIZE OF THE CYST IN THE UNCINATE INCREASE AND THE DIAMETER OF THE MPD REACH 7 MM. IN THE TAIL, A CYST INCREASE FROM 20 TO 28 MM
SCHEDULED FOR AN EUS EVALUATION +/- FNA AND CONTRAST ENHANCED IMAGING
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CASE N°8
Mr FENO….,MALE, 67 YEARS OLD
JUNE 2019 : FINDING A DIABETES
JULY 2019: Ct SCAN & MRI SHOWED A DILATION OF THE MPD
PATIENT IS ASYMPTOMATIC
SCHEDULED FOR A DIAGNOSTIC EUS CCP ?
MAIN DUCT IPMN ?
AMPULLARY TUMOR ?
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CASE N°9
Mr JOVA…., MALE, 60 YEARS OLD
2000 : ACUTE ALCOHOLIC PANCREATITIS
CALCIFYING CHRONIC PANCREATITIS WITH EPIGASTRIC PAIN
MRCP: PANCREAS DIVISUM WITH A DORSAL DUCT DILATED
4/9/2019 : FAILURE TO CANNULATE THE MINOR PAPILLA
SCHEDULED FOR A SECOND ERCP WITH MINOR PAPILLA CANNULATION
IF FAILURE : PANCREATICO- BULBOSTOMY GUIDED BY EUS
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CASE N°10
Mr MOR…, MALE, 72 YEARS OLD
JUNE 2019 : ASTHENIA, WEIGHT LOSS, CHOLESTASIS , CHRONIC RENAL INSUFFISANCY, HYPOTHYROIDISM
SEPTEMBER 2019: Ct SCAN : CHOLANGIOCARCINOMA SEGMENT 4 AND 5 WITH ARTERIAL INVOLVEMENT AND PARTIAL PORTAL VEIN THROMBOSIS
SCHEDULED FOR ERCP WITH BIOPSIES , BRUSHING AND BILIARY DRAINAGE
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CASE N°11
Mr MAR….,MALE, 46 YEARS OLD
GERD SINCE 10 YEARS
DECEMBER 2018: EGD BARRETT’S ESOPHAGUS C1M3
BIOPSIES: LOW GRADE DYSPLASIA
PPI : 40 MG X 2 (ESOMEPRAZOLE)
APRIL 2019 : EGD : SAME RESULTS, LGD CONFIRMED BY 2 PATHOLOGISTS
SCHEDULED FOR CONFOCAL EXAMINATION FOLLOW BY HYBRID-APC
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CASE 12
Mr PEDR…, FEMALE, 71 YEARS OLD
AUGUST 2019: ISOLATED JAUNDICE WITH CHOLESTASIS
Ct-SCAN & MRI : CHOLANGIOCARCINOMA TYPE IIIA BISTMUTH CLASSIFICATION WITH CELIAC AND LOMBO-AORTIC LN
EUS SHOWED CELIAC LN, EUS-FNA : NO MALIGNANT CELLS
SCHEDULED FOR BRUSHING, BIOPSIES AND BILIARY DRAINAGE METALLIC OR PLASTIC STENT ?
UNI OR BI-LATERAL DRAINAGE ?
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CASE N°13
Mr PA…, MALE, 69 YEARS OLD MALE
2007: ESOPHAGECTOMY FOR AN ADENOCARCINOMA pT1bN0M0
2010 : REGURGITATION WITH RECURRENT PNEUMOPATHIES
2018-2019: 6 HOSPITALISATIONS FOR SEVERE PULMONARY INFECTIONS
EGD: PYLORIC SPASM, CONFIRMED BY THE GASTROGRAFFIN TRANSIT
SCHEDULED FOR G-POEM
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CASE N°14
Mr GER…, MALE, 80 YEARS OLD
AUGUST 2019: ASTHENIA, WEIGHT LOSS AND JAUNDICE
CT-SCAN & MRI: SUSPICION OF CHOLANGIOCARCINOMA TYPE IV BSIMUTH CLASSIFICATION
9/9/2019: ERCP / LEFT LOBE WAS DRAINED BY A 12 CM/10F PLASTIC STENT AND THE RIGHT LOBE BY AN INTERNAL-EXTERNAL PERCUTANEOUS DRAIN
PATIENT WAS INCLUDED IN BILIARY RFA PROTOCOLE
SCHEDULED FOR BILIARY RFA AND STENTING
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CASE N°15
Mr SER…, MALE, 69 YEARS OLD 18/12/2017: LEFT NEPHRECTOMY FOR CARCINOMA APRIL 2019: Ct-SCAN SHOWED A PANCREATIC LESION IN THE BODY OF 14 MM
OF DIAMETER EUS-FNA: PANCREATIC METASTASIS FROM A RENAL CANCER, BUT THE EUS
SHOWED 3 LESIONS, 1 IN HEAD OF 4 MM, 1 IN THE ISTHMUS OF 6 MM AND THE THIRD IN THE BODY OF 14 MM
2/5/2019: INCLUSION IN PANCREATIC RFA PROTOCOLE FIRST SESSION OF PANCREATIC RFA
2/7/2019: EVALUATION : PARTIAL NECROSIS 50% SCHEDULED FOR A SECOND SESSION OF RFA GUIDED BY SONOVUE
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CASE N°16
Mr BAJ…, MALE, 70 YEARS OLD JULY 2019 : EPIGASTRIC PAIN, WEIGHT LOSS AND JAUNDICE Ct-SACN SHOWED A PANCREATIC MASS IN THE HEAD OF THE PANCREAS EUS-FNA: PANCREATIC ADENOCARCINOMA 25/7/2019: METALLIC STENT OF 6 CM/10MM WAS INSERTED SEPTEMBER 2019 : VOMITING, STILL JAUNDICE AND WEIGHT LOSS 9/9/2019 : DUODENAL STENT WAS INSERTED Ct6sCAN SHOWED A DYSFUNCTION OF THE BILIARY STENT SCHEDULED FOR HEPATICO-GASTROSTOMY
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CASE N°17
Mr SAL…, MALE, 41 YEARS OLD
2018: DIABETES, ALCOHOL ABUSER
SEPTEMBER 2019: WEIGHT LOSS (< 10 Kg), EPIGASTRIC PAIN
LIPASE > 2000 UI/L, GGT=1200 UI, ASAT=600, ALAT= 1000, BILIRUBIN= 48 MMOL/L
Ct-SCAN: DILATION OF THE MPD WITH PANCREATIC STONES, A PSEUDO-CYST OF 40 MM IN THE HEAD OF THE PANCREAS AND A BILIARY STENOSIS OF THE CBD WITH IHBD DILATED
SCHEDULED FOR ERCP AND BILIARY DRAINAGE AND PSEUDO-CYST DRAINAGE TRANS MURAL OR TRANS PAPILLAIRE ?
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CASE 18
Mr JOUA…, MALE, 64 YEARS OLD
ALCOHOL ABUSER
LONG BARRETT’S ESOPHAGUS C2M8
JULY 2019: RANDOM BIOPSIES SHOWED IN SITU CARCINOMA AT 32 CM OF THE DENTAL ARCHES
SCHEDULED FOR NEW EGD WITH MAPPING AND RESECTION OF THE IN SITU CARCINOMA ESD OR EMR WITH BAND LIGATION ???
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CASE N°19
Mrs TOUC…, MALE, 70 YEARS OLD
AUGUST 2019: BILIARY ACUTE PANCREATITIS WITH LIPASEMIA > 5000 UI/L
Ct-SCAN SHOWED A CIRRHOTIC LIVER (ALCOHOL ABUSER) AND A DILATED CBD WITH AN IMAGE OF STONE
EUS HAS CONFIRMED THE CBD STONE
9/9/2019 ERCP FAILED TO CANNULATE AN INTRA DIVERTICULAR PAPILLA AND THE PATIENT WAS REFERRED FOR A SECOND ATTEMPT
SCHEDULED FOR ERCP AND BILE DUCT STONE EXTRACTION
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CASE N°20
Mr KOH….,MALE, 82 YEARS OLD
AUGUST 2019 : PET-SCAN FOR THE STAGING OF BLADDER CANCER
PET-SCAN SHOWED AN HYPERFIXATION IN THE RECTUM
SIGMOIDOSCOPY FOUND A RECTAL POLYP TYPE MIXT LST+ NODULAR AREA
SCHEDULED FOR EMR
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CASE N°21
Mr PERG…., MALE, 77 YEARS OLD
2 AND 4 SEPTEMBER 2019: CHOLANGITIS DUE TO BILIARY STONES
2 ATTEMPTS OF ERCP WITH PRE-CUTTING AND FAILURE TO DEEP CANNULATION OF THE CBD
PATIENT IS REFERRED THE 6/9/2019 IN OUR HOSPITAL WITH A CLINICAL OF BILIARY PERITONITIS PROBABLY DUE TO AN INJURY OF THE CBD
Ct-SCAN SHOWED PERITONEAL FLUID, SURGERY WAS PERFORMED IN EMERGENCY AND CONFIRMED THE DIAGNOSIS OF BILE PERITONITIS
PERITONEAL LAVAGE WAS PERFORMED AND THE BILE DUCT WAS DRAINED BY A KHER DRAIN
12/9/2019: MRCP SHOWED MULTIPLE LARGE CBD STONES
SCHEDULED FOR STONE EXTRACTION OR SPY GLASS LITHOTRYPSY
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CASE N°22
MrS D’ORA…,FEMALE, 73 YEARS OLD
JUNE 2019 : DIARHHEA SINCE 2 MONTHS
COLONOSCOPY: VILLOUS POLYP OF 4 CM IN THE RECTM
ERUS : LESION usT1N0
SCHEDULED FOR ENDOSCOPIC RESECTION EMR ?
ESD ?
BEFORE RESECTION NEW ENDOSCOPIC STAGING +/- ERUS
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CASE N°23
Mr MAT…., MALE, 82 YEAR OLD
END OF AUGUST 2019: JAUNDICE, WEIGT LOSS
Ct-SCAN SHOWED A PANCREATIC MASS IN THE HEAD OF THE PANCREAS WITH INVOLVEMENT OF THE SMV
BILIRUBIN LEVEL > 250 MMOL/L
SCHEDULED FOR EUS-FNA AND BILIARY DRAINAGE DURING THE SAME SESSION
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