简介：Endoscopicultrasonography-guidedfine-needleaspiration（EUS-FNA）hasbeenappliedtopancreaticobiliarylesionssincethe1990sandisinwidespreadusethroughouttheworldtoday.Weusedthismethodtoconfirmthepathologicalevidenceofthepancreaticobiliarylesionsandtoperformsuitabletherapies.ComplicationsofEUS-FNAarequiterare,butsomeofthemaresevere.OperatorsshouldmasterconventionalEUSobservationandexperienceaminimumof20-30casesofsupervisedEUS-FNAonnon-pancreaticandpancreaticlesionsbeforeattemptingsoloEUSFNA.StudiesconductedonpancreaticobiliaryEUSFNAhavefocusedonselectionofsuitableinstruments（e.g.,needleselection）andsamplingtechniques（e.g.,fanningmethod,suctionlevel,withorwithoutastylet,optimumnumberofpasses）.Today,thediagnosticabilityofEUS-FNAisstillimproving;thedetectionofpancreaticcancer（PC）currentlyhasasensitivityof90%-95%andspecificityof95%-100%.InadditiontoPC,avarietyofrarepancreatictumorscanbediscriminatedbyconductingimmunohistochemistryontheFNAmaterials.Aflexible,largecaliberneedlehasbeenusedtoobtainalargepieceoftissue,whichcanprovidesufficienthistologicalinformationtobehelpfulinclassifyingbenignpancreaticlesions.EUSFNAcansupplyhighdiagnosticyieldsevenforbiliarylesionsorperi-pancreaticobiliarylymphnodes.ThisreviewfocusesontheclinicalaspectsofEUS-FNAinthepancreaticobiliaryfield,withtheaimofprovidinginformationthatcanenablemoreaccurateandefficientdiagnosis.

简介：AIM:Toinvestigatethediagnosticaccuracyofthemeanplateletvolumeandplateletdistributionwidthinacuteappendicitis.METHODS:Thisretrospective,case-controlledstudycompared295patientswithacuteappendicitis(Group?Ⅰ),100patientswithotherintra-abdominalinfections(GroupⅡ),and100healthyindividuals(GroupⅢ)betweenJanuary2012andJanuary2013.Theage,gender,andwhitebloodcellcount,neutrophilpercentage,meanplateletvolume,andplateletdistributionwidthvaluesfrombloodsampleswerecomparedamongthegroups.StatisticalanalyseswereperformedusingSPSSforWindows21.0software.Inaddition,thesensitivity,specificity,positiveandnegativepredictivevaluesandlikelihoodratios,anddiagnosticaccuracywerecalculated.RESULTS:Themeanagesofpatientswere29.9±12.0yearsforGroup?Ⅰ,31.5±14.0yearsforGroupⅡ,and30.4±13.0yearsforGroupⅢ.Demographicfeaturessuchasageandgenderwerenotsignificantlydifferentamongthegroups.Whitebloodcellcount,neutrophilpercentageandplateletdistributionwidthweresignificantlyhigherinGroup?Ⅰ?comparedtogroupsⅡandⅢ(P<0.05).Diagnostically,thesensitivity,specificityanddiagnosticaccuracywere73.1%,94.0%,and78%forwhitebloodcellcount,70.0%,96.0%,and76.0%forneutrophilpercentage,29.5%,49.0%,and34.0%formeanplateletvolume,and97.1%,93.0%,and96.0%forplateletdistributionwidth,respectively.ThehighestdiagnosticaccuracydetectedwasforplateletdistributionwidthbetweenGroup?Ⅰ?andGroupⅢ(P<0.01).CONCLUSION:Plateletdistributionwidthanalysiscanbeusedfordiagnosisofacuteappendicitiswithoutrequiringadditionaltests,thusreducingthecostandlossoftime.

简介：瞄准：与胃肠的graft-versus-host疾病(官方补给的GVHD)在病人评估内视镜检查法的诊断价值。方法：我们与官方补给的GVHD后面的allogeneic识别了8个病人造血的干细胞移植(HSCT)。GVHD组织学地被定义为腺apoptosis的存在，没由另外的煽动性或传染的病原学解释。结果：官方补给的GVHD的症状包括了厌食，恶心，呕吐，水泻，腹的疼痛，官方补给的流血，等等。上面的内视镜的外观从微妙的粘膜浮肿变化了，充血，红斑到明显的侵蚀。Colonoscopic检查显示出弥漫的浮肿，充血，补缀的侵蚀，散布溃疡，腐肉形成并且活跃流血。在官方补给的GVHD的组织学的变化在上皮和薄板propria包括了地窟上皮细胞，地窟的退学学生，和淋巴球的渗入的apoptosis。胃和书籍的右页冒号的参与从diffuse变化了到焦点。结论：内视镜检查法可以在跟随allogeneicHSCT的官方补给的GVHD病人的早诊断起一个重要作用，并且胃肠的活体检视的histologic检查被需要证实最后的诊断。

简介：Pancreaticcysticlesions(PCLs)areincreasinglybeingidentifiedbecauseofthewidespreaduseofhighresolutionabdominalimaging.Thesecystsencompassaspectrumfrommalignantdiseasetobenignlesions,andtherefore,accuratediagnosisiscrucialtodeterminethebestmanagementstrategy,eithersurgicalresectionorsurveillance.However,thecurrentstandardofdiagnosisisnotaccurateenoughduetolimitationsofimagingandtissuesamplingtechniques,whichentailtheriskofunnecessaryburdensomesurgeryforbenignlesionsormissedopportunitiesofprophylacticsurgeryforpotentiallymalignantPCLs.Inthelastdecade,endoscopicinnovationsbasedonendoscopicultrasonography(EUS)imaginghaveemerged,aimingtoovercomethepresentlimitations.ThesenewEUS-basedtechnologiesarecontrastharmonicEUS,needle-basedconfocalendomicroscopy,through-the-needlecystoscopyandthrough-theneedleintracysticbiopsy.Here,wepresentacomprehensiveandcriticalreviewoftheseemergingendoscopictoolsforthediagnosisofPCLs,withaspecialemphasisonfeasibility,safetyanddiagnosticperformance.

简介：AIM:Todeterminetheclinicalvalueofdiffusion-weight-edimaging(DWI)forthediagnosisofextrahepaticcholangiocarcinoma(EHCC)bycomparingthediagnosticsensitivityofDWIandmagneticresonancecholan-giopancreatography(MRCP).METHODS:Magneticresonanceimagingexaminationwasperformedin56patientswithsuspectedEHCC.T1-weightedimaging,T2-weightedimaging,MRCPandDWIsequence,DWIusingsingle-shotspin-echoechoplanarimagingsequencewithdifferentbvalues(100,300,500,800and1000s/mm2),wereperformed.Allcaseswerefurtherconfirmedbysurgeryorhistopathologicaldiagnosis.TworadiologistsjointlyperformedtheanalysisoftheDWIandMRCPimages.Apparentdiffusioncoefficient(ADC)valueandsignal-noiseratiowerecalculatedforEHCC.Sensitivity,specificity,accuracy,positivepredictivevalueandnegativepredictivevalueweretestedusingDWIwithabvalueof500s/mm2andMRCPimages,respectively.RESULTS:Histopathologicaldiagnosisconfirmedthatamongthe56cases,35wereEHCC(20hilarand15distalextrahepatic),16werecholangitis,and5werecal-culusofbileduct.Thirty-threeoutofthe35EHCCcasesweredetectedbyDWI.EHCCexhibiteddifferentiallevelsofhighsignalintensityinDWIandlowsignalintensityintheADCmap.ThemeanvalueforADCwas(1.31±0.29)×10-3mm2/s.ThedetectionrateofEHCCwassignificantlyhigherbyDWI(94.3%)thanbyMRCP(74.3%)(P<0.05).Therewasasignificantdifferenceinsensitivity(94.3%vs74.3%),specificity(100%vs71.4%),accu-racy(96.4%vs73.2%),positivepredictivevalue(100%vs81.3%),andnegativepredictivevalue(91.3%vs62.5%)betweenDWIandMRCPindiagnosingEHCC.CONCLUSION:DWIhasahighsensitivityforthedetectionofEHCCasitshowstheEHCClesionmoreunambiguouslythanMRCPdoes.DWIcanalsoprovideadditionalclinicallyimportantinformationinEHCCpatientswhenaddedtoroutinebileductMRimagingprotocols.

简介：AIM:Tostudythediagnosisofhepatocellularcarcinoma(HCC)presentingasbileducttumorthrombuswithnodetectableintrahepaticmass.METHODS:SixpatientswithpathologicallyprovenbileductHCCthrombibutnointrahepaticmassdemonstratedonthepreoperativeimagingorpalpatedintrahepaticmassduringoperativeexploration,werecollected.Theirclinicalandimagingdatawereretrospectivelyanalyzed.Themajorfindingsorsignsoncomprehensiveimagingwerecorrelatedwiththesurgicalandpathologicfindings.RESULTS:Jaundicewasthemajorclinicalsymptomofthepatients.Theelevatedserumtotalbilirubin,directbilirubinandalanineaminotransferaselevelswereinconcordancewithobstructivejaundiceandtheunderlyingliverdisease.Ofthe6patientsshowingevidenceofviralhepatitis,5werepositiveforserumalphafetoproteinandcarbohydrateantigen19-9,and1waspositiveforserumcarcinoembryonicantigen.Nopatientwascorrectlydiagnosedbyultrasound.Themainfeaturesofpatientsoncomprehensiveimagingwerefillingdefectswithcup-shapedendsofthebileduct,withlargefillingdefectspresentingascastingmouldsintheexpandedbileduct,hypervascularintraluminalnodules,debrisorbloodclotsinthebileduct.Noobviouscircularthickeningofthebileductwallswasobserved.CONCLUSION:Evenwithnodetectableintrahepatictumor,bileductHCCthrombusshouldbeconsideredinpatientspredisposedtoHCC,andsomeimagingsignsareindicativeofitsdiagnosis.

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简介：瞄准：为了评估胰腺的织物的组织学的评估的诊断精确性，一个修改方法为恢复并且处理内视镜的超声(EUS)获得的样品指导了好针渴望(FNA)在胰腺的固体的鉴别诊断的材料集中。方法：有胰腺的群众的62个连续病人有希望地被学习。EUS被线性扫描PentaxFG-38UX回响内诊镜执行。三FNA(22G针)在每个过程期间被执行。与第一和第二根刺获得的材料为cytological学习被处理。第三根刺的材料被盐溶液的小心的注射通过针为摩尔答案恢复进10%，并且为组织学的学习处理了。结果：一些为组织学的分析获得的核心标本是6.5+/-5.3公里(范围1-22公里)。Cytological和组织学的样品在51被看作足够(82.3%)并且52个盒子(83.9%)分别地。为恶意的诊断的胰腺的细胞学和组织学的全面敏感是68.4%。与细胞学相反，组织学能诊断除煽动性的群众的腺癌，和所有情况以外的瘤。细胞学和组织学的联合允许在56种情况(90.3%)中获得一件足够的样品，与84.21%的全球敏感，100%的特性和90.32%的全面精确性。复杂并发症率是1.6%。结论：为组织学的检查的足够的胰腺的核心标本能被指导EUS的FNA获得。这种技术为胰腺的瘤的不同类型和良性的疾病的评估的诊断主要是有用的。

简介：Superficialnon-ampullaryduodenalepithelialtumor(SNADET)isdefinedasasporadictumorthatisconfinedtothemucosaorsubmucosathatdoesnotarisefromVater’spapilla,anditincludesadenomaandadenocarcinoma.Recentdevelopmentsinendoscopictechnology,suchashigh-resolutionendoscopyandimage-enhancedendoscopy,mayincreasethechancesofdetectingSNADETlesions.However,becauseSNADETisrare,littleisknownaboutitspreoperativeendoscopicdiagnosis.TheuseofendoscopicresectionforSNADET,whichhasnoriskofmetastasis,isincreasing,buttheincidenceofcomplications,suchasperforation,issignificantlyhigherthaninanyotherpartofthedigestivetract.Apreoperativediagnosisisrequiredtodistinguishbetweenlesionsthatshouldbefollowedupandthosethatrequiretreatment.Retrospectivestudieshaverevealedcertainendoscopicfindingsthatsuggestmalignancy.Inrecentyears,severalnewimagingmodalitieshavebeendevelopedandexploredforrealtimediagnosisoftheselesiontypes.EstablishinganendoscopicdiagnostictooltodifferentiatebetweenadenomaandadenocarcinomainSNADETlesionsisrequiredtoselectthemostappropriatetreatment.ThisreviewdescribesthecurrentstateofknowledgeaboutpreoperativeendoscopicdiagnosisofSNADETs,suchasduodenaladenomaandduodenaladenocarcinoma.Newerendoscopictechniques,includingmagnifyingendoscopy,mayhelptoguidethesediagnostics,buttheiradditionaladvantagesremainunclear,andfurtherstudiesarerequiredtoclarifytheseissues.