Shil B C, Banik R K, Saha S K, Faruque M O, Islam A S M N, Rahman M H
Bangladesh Med Res Counc Bull. 2015 Apr;41(1):41-5. doi: 10.3329/bmrcb.v41i1.30313.
Since its introduction in early 1990s, endoscopic ultrasound (EUS) has become integral to the diagnosis and staging of various luminal, extraluminal gastrointestinal (GI) and certain non-GI lesions. There is no data on EUS experience in Bangladesh. The aim of this paper is to evaluate the initial recent experience and clinical impact of EUS. All EUS procedures data were recorded prospectively from July 2013 to December 2014. These included patients' demographics, referral details, provisional diagnosis, management plan before and after EUS & indications of procedures. EUS-FNA data recorded included details regarding site, number of passes and histological diagnosis. Two hundred & four EUS procedures were carried out over one and half years. Male female ratio was 1.4:1, mean age was 46.4 ± 20 years. Of these procedures 148 (72.5%) were referrals from physicians and 56 (27.5%) were from surgeons. Most common indications were pancreatobiliary pathologies, esophageal & gastric pathologies. Pancreatobiliary lesions (n = 165, 80.9%) included patients with (A) Benign pathologies: Microliths in Gall baldder (n = 6), Gall stones (n = 12), Biliary ascarrisis (n = 22), Choledocholithiasis (n = 42), Acute Pancreatitis (n = 9), Chronic Pancreatitis (n = 15), Pancreatic pseudocysts(n = 4) (B) Malignant Pathologies : GB Carcinoma (n = 4), Cholangiocarcinoma (n = 29), Ca- pancreas (n = 9), Periampullary carcinoma (n = 12). Esophageal lesion was 9.3% (n = 19) of total procedures. Forty seven percent (n = 9) of EUS procedures on esophagus were for staging of esophageal malignancy, 10. 5% (n = 2) for restaging or recurrence after chemoradiation and 21% (n = 4) for submucosal lesions. Fifteen EUS procedures were carried out for gastric lesions, seven were for staging of gastric carcinoma, four were for assessment of submucosal lesions (e.g. GIST, lipoma or external compression), 02 for assessment of polyps and two for gastric ulcers.In clinical impact & outcome study, changes in diagnosis, management, avoidance of investigations and usefulness of EUS were evaluated. Diagnosis was changed in 34.4% (64/186) & management was changed in 45%(92/204). Additional investigation was avoided in 57.8% (118/204). This is the first report of Bangladesh experience of EUS to date. EUS is safe, accurate, cost effective & very useful tool for diagnosis and management of G.I. disorders.
自20世纪90年代初引入以来，内镜超声（EUS）已成为各种腔内、腔外胃肠道（GI）及某些非胃肠道病变诊断和分期不可或缺的手段。在孟加拉国，尚无关于EUS应用经验的数据。本文旨在评估近期EUS的初步应用经验及其临床影响。前瞻性记录了2013年7月至2014年12月期间所有EUS检查的数据。这些数据包括患者的人口统计学信息、转诊详情、初步诊断、EUS检查前后的管理计划以及检查指征。记录的EUS - FNA数据包括穿刺部位、穿刺次数及组织学诊断等详细信息。在一年半的时间里共进行了204例EUS检查。男女比例为1.4:1，平均年龄为46.4±20岁。其中，148例（72.5%）是由内科医生转诊而来，56例（27.5%）是由外科医生转诊而来。最常见的检查指征是胰胆疾病、食管及胃部疾病。胰胆病变（n = 165，80.9%）包括：（A）良性病变：胆囊微结石（n = 6）、胆结石（n = 12）、胆道蛔虫病（n = 22）、胆总管结石（n = 42）、急性胰腺炎（n = 9）、慢性胰腺炎（n = 15）、胰腺假性囊肿（n = 4）；（B）恶性病变：胆囊癌（n = 4）、胆管癌（n = 29）、胰腺癌（n = 9）、壶腹周围癌（n = 12）。食管病变占总检查数的9.3%（n = 19）。对食管进行的EUS检查中，47%（n = 9）用于食管癌分期，10.5%（n = 2）用于放化疗后的再分期或复发评估，21%（n = 4）用于黏膜下病变评估。对胃部病变进行了15例EUS检查，其中7例用于胃癌分期，4例用于评估黏膜下病变（如胃肠道间质瘤、脂肪瘤或外部压迫），2例用于评估息肉，2例用于胃溃疡评估。在临床影响及结果研究中，评估了诊断的改变、管理的改变、避免的检查以及EUS的实用性。3
