Amir Houshang Mohammad Alizadeh

By Amir Houshang Mohammad Alizadeh

Pancreatic cystic lesions (PCLs) comprise various pathologically different groups of lesions that usually share many common clinical features. Cystic lesions and fluid collections of the pancreas often present a diagnostic and therapeutic challenge. Pancreatic cystic lesions are being diagnosed with increasing frequency owing to the widespread use of cross-sectional imaging. The differential diagnosis for cystic lesions of the pancreas is broad, and the role of endoscopic ultrasonography (EUS) is becoming more clearly defined. EUS has become an important tool in the diagnosis and risk stratification of pancreatic cysts. The ability of EUS to provide detailed imaging, tissue, and cyst fluid for analysis makes it a seemingly powerful diagnostic tool for PCLs. It can accurately visualize the cyst morphology, assess vascular pattern by contrast harmonic scan, and perform fine-needle aspiration (FNA) for evaluation of cytology and molecular markers. Furthermore, several studies have shown the therapeutic applications of endoscopic ultrasound in management of PCLs, including EUS-guided ablation of cystic pancreatic tumors by injection of alcohol, aiding in pancreatic pseudocyst drainage.

Part of the book: Endoscopic Ultrasound

By Amir Houshang Mohammad Alizadeh

Diseases of the gallbladder commonly manifest as cholelithiasis and gallbladder cancer. Cholelithiasis has become a significant health problem in developed societies, affecting 10–15% of the adult population. Gallbladder polyps are incidentally detected in approximately 4–7% of patients. In addition, other gallbladder problems may also occur, but these are extremely rare: remnant cystic duct, gallbladder anomalies, Mirizzi syndrome, and gallbladder parasites. Endoscopic ultrasound (EUS) is an excellent method for visualizing the bile duct and gallbladder given its proximity when imaging from the duodenum. EUS can be used for evaluation of gallbladder disease that includes investigation of suspected cholelithiasis or biliary sludge, imaging of polypoid lesions of the gallbladder, and diagnosis and staging of gallbladder cancer. This procedure can be helpful to further distinguish benign from malignant or potentially malignant gallbladder polyps and play an important role in determining the treatment strategy for gallbladder polyps. Furthermore, EUS can help in the diagnosis of rarely gallbladder diseases such as remnant cystic duct, gallbladder anomalies, Mirizzi syndrome, and gallbladder parasites. Recent studies have suggested that EUS‐guided gallbladder drainage (EUS‐GBD) can be considered to be an effective emergency treatment for acute cholecystitis patients at high risk for surgery.

Part of the book: Updates in Gallbladder Diseases