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Pancreatic Neoplasms: HELP
Articles by Mohamad A. Eloubeidi
Based on 38 articles published since 2008

Between 2008 and 2019, M. Eloubeidi wrote the following 38 articles about Pancreatic Neoplasms.
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline The role of endoscopy in the diagnosis and treatment of cystic pancreatic neoplasms. 2016

Anonymous6580868 / Muthusamy, V Raman / Chandrasekhara, Vinay / Acosta, Ruben D / Bruining, David H / Chathadi, Krishnavel V / Eloubeidi, Mohamad A / Faulx, Ashley L / Fonkalsrud, Lisa / Gurudu, Suryakanth R / Khashab, Mouen A / Kothari, Shivangi / Lightdale, Jenifer R / Pasha, Shabana F / Saltzman, John R / Shaukat, Aasma / Wang, Amy / Yang, Julie / Cash, Brooks D / DeWitt, John M. · ·Gastrointest Endosc · Pubmed #27206409.

ABSTRACT: -- No abstract --

2 Guideline The role of endoscopy in the evaluation and management of patients with solid pancreatic neoplasia. 2016

Anonymous1760853 / Eloubeidi, Mohamad A / Decker, G Anton / Chandrasekhara, Vinay / Chathadi, Krishnavel V / Early, Dayna S / Evans, John A / Fanelli, Robert D / Fisher, Deborah A / Foley, Kimberly / Hwang, Joo Ha / Jue, Terry L / Lightdale, Jenifer R / Pasha, Shabana F / Saltzman, John R / Sharaf, Ravi / Shergill, Amandeep K / Cash, Brooks D / DeWitt, John M. · ·Gastrointest Endosc · Pubmed #26706297.

ABSTRACT: -- No abstract --

3 Editorial Sampling para-aortic lymph nodes in pancreatic and biliary cancers with EUS-guided FNA: diagnostic, clinical, and therapeutic implications. 2016

El Hajj, Ihab I / Eloubeidi, Mohamad. ·Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA. · Anniston Digestive Health, Anniston, Alabama, USA. ·Gastrointest Endosc · Pubmed #27530480.

ABSTRACT: -- No abstract --

4 Editorial Diagnosis of pancreatic cancer by contrast-harmonic endoscopic ultrasound (EUS): complementary and not competitive with EUS-guided fine-needle aspiration. 2014

Fusaroli, Pietro / Eloubeidi, Mohamad A. ·American University of Beirut Medical Center, Beirut, Lebanon. ·Endoscopy · Pubmed #24740402.

ABSTRACT: -- No abstract --

5 Editorial Biliary findings and the neoplastic potential of branch duct intraductal papillary mucinous neoplasm. 2013

Buxbaum, James L / Eloubeidi, Mohamad A. · ·Clin Gastroenterol Hepatol · Pubmed #23395700.

ABSTRACT: -- No abstract --

6 Editorial Molecular and clinical markers of pancreas cancer. 2010

Buxbaum, James L / Eloubeidi, Mohamad A. · ·JOP · Pubmed #21068484.

ABSTRACT: Pancreas cancer has the worst prognosis of any solid tumor but is potentially treatable if it is diagnosed at an early stage. Thus there is critical interest in delineating clinical and molecular markers of incipient disease. The currently available biomarker, CA 19-9, has an inadequate sensitivity and specificity to achieve this objective. Diabetes mellitus, tobacco use, and chronic pancreatitis are associated with pancreas cancer. However, screening is currently only recommended in those with hereditary pancreatitis and genetic syndromes which predispose to cancer. Ongoing work to identify early markers of pancreas cancer consists of high throughput discovery methods including gene arrays and proteomics as well as hypothesis driven methods. While several promising candidates have been identified none has yet been convincingly proven to be better than CA 19-9. New methods including endoscopic ultrasound are improving detection of pancreas cancer and are being used to acquire tissue for biomarker discovery.

7 Review Diagnostic yield of EUS-guided FNA for malignant biliary stricture: a systematic review and meta-analysis. 2016

Sadeghi, Anahita / Mohamadnejad, Mehdi / Islami, Farhad / Keshtkar, Abbas / Biglari, Mohammad / Malekzadeh, Reza / Eloubeidi, Mohamad A. ·Liver and Pancreatobiliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran. · American Cancer Society, Atlanta, Georgia, USA. · Anniston Digestive Health, Anniston, Alabama, USA. ·Gastrointest Endosc · Pubmed #26422979.

ABSTRACT: BACKGROUND AND AIMS: EUS-guided FNA (EUS-FNA) is increasingly being used for tissue diagnosis of extrahepatic biliary strictures. The aim of this study was to determine the diagnostic yield of EUS-FNA in malignant biliary strictures. METHODS: A comprehensive literature review was carried out by 2 reviewers for studies evaluating the accuracy of EUS-FNA in biliary stricture. A meta-analysis was performed to determine the pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio for EUS-FNA of extrahepatic biliary stricture. A Quality Assessment of Diagnostic Accuracy Studies questionnaire was used to assess the quality of the selected studies. Several sensitivity analyses were performed to assess the effect of the quality of the studies on the accuracy of the final results of the meta-analysis. RESULTS: Twenty studies involving 957 patients met inclusion criteria and were included in the meta-analysis. The pooled sensitivity and specificity of EUS-FNA for diagnosis of malignant biliary stricture were 80% (95% confidence interval [CI], 74%-86%), and 97% (95% CI, 94%-99%), respectively. The pooled positive likelihood ratio was 12.35 (95% CI, 7.37-20.72), and the negative likelihood ratio was 0.26 (95% CI, 0.18-0.38). The pooled diagnostic odds ratio for diagnosing a malignant biliary stricture was 70.53 (95% CI, 38.62-128.82). The area under the receiver-operating characteristic curve was 0.97. Sensitivity analyses showed that the quality of the included studies did not affect the accuracy of the final results of the meta-analysis. CONCLUSION: This meta-analysis demonstrates that EUS-FNA is sensitive and highly specific for diagnosing malignancy in biliary strictures. Further studies are needed to compare EUS--FNA with emerging methods including cholangioscopy-guided biopsy and laser endomicroscopy.

8 Review Cystsic lesions of the pancreas. 2013

Mohamadnejad, Mehdi / Eloubeidi, Mohamad A. ·Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran. ·Arch Iran Med · Pubmed #23496368.

ABSTRACT: Pancreatic cysts (PCs) are being increasingly detected due to the widespread use of high-resolution abdominal imaging. The main imaging modalities to diagnose PCs include high-resolution spiral CT scan, MRI, and endoscopic ultrasound (EUS). EUS has the added benefit of enabling cyst fluid sampling through FNA and significantly improves clinical diagnosis of PCs. Some PCs like pseudocysts, serous cystadenomas, and lymphoepethelial cysts are entirely benign lesions and can be managed non-operatively. However, other lesions like mucinous cystic neoplasms, or cystic neuroendocrine tumors are pre-malignant or malignant lesions and require surgical intervention. In this review, we describe diagnosis and management of common pancreatic cystic lesions.

9 Review How good is endoscopic ultrasound-guided fine-needle aspiration in diagnosing the correct etiology for a solid pancreatic mass?: A meta-analysis and systematic review. 2013

Puli, Srinivas R / Bechtold, Matthew L / Buxbaum, James L / Eloubeidi, Mohamad A. ·Division of Gastroenterology and Hepatology, Massachusetts General Hospital and Brigham Women's Hospital, Harvard School of Medicine, Boston, MA, USA. srinivaspuli@yahoo.com ·Pancreas · Pubmed #23254913.

ABSTRACT: OBJECTIVES: The objective of this study was to evaluate the accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in diagnosing the correct etiology for a solid pancreatic mass. METHOD: Data extracted from EUS-FNA studies with a criterion standard (either confirmed by surgery or appropriate follow-up) were selected. Articles were searched in MEDLINE, CINAHL, and Cochrane Central Register of Controlled Trials & Database of Systematic Reviews. Pooling was conducted by both fixed- and random-effects models. RESULTS: Initial search identified 3610 reference articles, of these 360 relevant articles were selected and reviewed. Data were extracted from 41 studies (N = 4766) which met the inclusion criteria. Pooled sensitivity of EUS-FNA in diagnosing the correct etiology for solid pancreatic mass was 86.8% (95% confidence interval [CI], 85.5-87.9). Endoscopic ultrasound-guided FNA had a pooled specificity of 95.8% (95% CI, 94.6-96.7). Positive likelihood ratio of EUS was 15.2 (95% CI, 8.5-27.3), and the negative likelihood ratio was 0.17 (95% CI, 0.13-0.21). CONCLUSIONS: Endoscopic ultrasound-guided FNA is an excellent diagnostic tool to detect the correct etiology for solid pancreatic masses. When available, EUS-FNA should be strongly considered as the first diagnostic tool for sampling these lesions to optimize patient management.

10 Review Pancreatico-biliary endoscopic ultrasound: a systematic review of the levels of evidence, performance and outcomes. 2012

Fusaroli, Pietro / Kypraios, Dimitrios / Caletti, Giancarlo / Eloubeidi, Mohamad A. ·Department of Clinical Medicine, University of Bologna, 40100 Bologna, Italy. pietro.fusaroli@unibo.it ·World J Gastroenterol · Pubmed #22969187.

ABSTRACT: Our aim was to record pancreaticobiliary endoscopic ultrasound (EUS) literature of the past 3 decades and evaluate its role based on a critical appraisal of published studies according to levels of evidence (LE). Original research articles (randomized controlled trials, prospective and retrospective studies), meta-analyses, reviews and surveys pertinent to gastrointestinal EUS were included. All articles published until September 2011 were retrieved from PubMed and classified according to specific disease entities, anatomical subdivisions and therapeutic applications of EUS. The North of England evidence-based guidelines were used to determine LE. A total of 1089 pertinent articles were reviewed. Published research focused primarily on solid pancreatic neoplasms, followed by disorders of the extrahepatic biliary tree, pancreatic cystic lesions, therapeutic-interventional EUS, chronic and acute pancreatitis. A uniform observation in all six categories of articles was the predominance of LE III studies followed by LE IV, II b, II a, I b and I a, in descending order. EUS remains the most accurate method for detecting small (< 3 cm) pancreatic tumors, ampullary neoplasms and small (< 4 mm) bile duct stones, and the best test to define vascular invasion in pancreatic and peri-ampullary neoplasms. Detailed EUS imaging, along with biochemical and molecular cyst fluid analysis, improve the differentiation of pancreatic cysts and help predict their malignant potential. Early diagnosis of chronic pancreatitis appears feasible and reliable. Novel imaging techniques (contrast-enhanced EUS, elastography) seem promising for the evaluation of pancreatic cancer and autoimmune pancreatitis. Therapeutic applications currently involve pancreaticobiliary drainage and targeted fine needle injection-guided antitumor therapy. Despite the ongoing development of extra-corporeal imaging modalities, such as computed tomography, magnetic resonance imaging, and positron emission tomography, EUS still holds a leading role in the investigation of the pancreaticobiliary area. The major challenge of EUS evolution is its expanding therapeutic potential towards an effective and minimally invasive management of complex pancreaticobiliary disorders.

11 Review The role of endoscopic ultrasonography in the evaluation of pancreatico-biliary cancer. 2010

Varadarajulu, Shyam / Eloubeidi, Mohamad A. ·Department of Gastroenterology and Hepatology and the Pancreatico-biliary Center, the University of Alabama at Birmingham, 1530 3rd Avenue, South - ZRB 636, Birmingham, AL 35294-0007, USA. ·Surg Clin North Am · Pubmed #20362785.

ABSTRACT: Accurate staging of pancreatico-biliary cancer is essential for surgical planning and for identification of locally advanced and metastatic disease that is incurable by surgery. The complex regional anatomy of the pancreatico-biliary system makes histologic diagnosis of malignancy at this region difficult. The ability to position the endoscopic ultrasound transducer at endoscopy in direct proximity to the pancreas and the bile duct, combined with the use of fine-needle aspiration, enables accurate preoperative staging of cancer, especially cancer too small to be characterized by CT or MRI. Endoscopic ultrasonography (EUS) identifies patients unlikely to be cured by surgery due to vascular invasion or regional nodal metastasis, thereby limiting procedure-related morbidity and mortality. This article focuses on the utility and recent advances of EUS in the evaluation of pancreatico-biliary cancer.

12 Review Interventional EUS for the diagnosis and treatment of locally advanced pancreatic cancer. 2010

Al-Haddad, Mohammad / Eloubeidi, Mohamad A. ·Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. ·JOP · Pubmed #20065544.

ABSTRACT: Endoscopic ultrasound (EUS) evolved as the diagnostic test of choice evaluating suspected pancreatic tumors. Coupled with fine needle aspiration (FNA), EUS provides high accuracy for the diagnosis and staging of pancreatic cancer. Novel EUS based techniques have emerged as a safe minimally invasive alternative to the surgical or radiological approaches. By allowing better pain control, delivering antitumor therapies or draining obstructed bile ducts, such techniques hold a big promise to improve the quality of life of patients with unresectable pancreatic cancer. In this review, we will discuss the role EUS-FNA plays in the diagnosis, staging and treatment of patients with locally advanced pancreatic cancer.

13 Clinical Trial A phase I study evaluating the role of the anti-epidermal growth factor receptor (EGFR) antibody cetuximab as a radiosensitizer with chemoradiation for locally advanced pancreatic cancer. 2011

Arnoletti, J P / Frolov, A / Eloubeidi, M / Keene, K / Posey, J / Wood, T / Greeno, Edward / Jhala, N / Varadarajulu, S / Russo, S / Christein, J / Oster, R / Buchsbaum, D J / Vickers, S M. ·Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA. ·Cancer Chemother Pharmacol · Pubmed #20589377.

ABSTRACT: PURPOSE: (1) To determine the safety of the epidermal growth factor receptor (EGFR) antibody cetuximab with concurrent gemcitabine and abdominal radiation in the treatment of patients with locally advanced adenocarcinoma of the pancreas. (2) To evaluate the feasibility of pancreatic cancer cell epithelial-mesenchymal transition (EMT) molecular profiling as a potential predictor of response to anti-EGFR treatment. METHODS: Patients with non-metastatic, locally advanced pancreatic cancer were treated in this dose escalation study with gemcitabine (0-300 mg/m(2)/week) given concurrently with cetuximab (400 mg/m(2) loading dose, 250 mg/m(2) weekly maintenance dose) and abdominal irradiation (50.4 Gy). Expression of E-cadherin and vimentin was assessed by immunohistochemistry in diagnostic endoscopic ultrasound fine-needle aspiration (EUS-FNA) specimens. RESULTS: Sixteen patients were enrolled in 4 treatment cohorts with escalating doses of gemcitabine. Incidence of grade 1-2 adverse events was 96%, and incidence of 3-4 adverse events was 9%. There were no treatment-related mortalities. Two patients who exhibited favorable treatment response underwent surgical exploration and were intraoperatively confirmed to have unresectable tumors. Median overall survival was 10.5 months. Pancreatic cancer cell expression of E-cadherin and vimentin was successfully determined in EUS-FNA specimens from 4 patients. CONCLUSIONS: Cetuximab can be safely administered with abdominal radiation and concurrent gemcitabine (up to 300 mg/m(2)/week) in patients with locally advanced adenocarcinoma of the pancreas. This combined therapy modality exhibited limited activity. Diagnostic EUS-FNA specimens could be analyzed for molecular markers of EMT in a minority of patients with pancreatic cancer.

14 Article Endoscopic Ultrasound Assessment of Pancreatic Duct Diameter Predicts Neuroendocrine Tumors and Other Pancreas Masses. 2019

Gupta, Nikhil / Kankotia, Ravi / Sahakian, Ara / Jayaram, Preeth / Shindel, Alex / Dong, Elizabeth / Korc, Paul / Eloubeidi, Mohamad / Buxbaum, James. ·Division of Gastroenterology, Department of Medicine, Kaiser Permanente Los Angeles, Los Angeles. · Department of Medicine, Division of Gastroenterology, Hoag Hospital, Newport Beach, CA. · Department of Medicine, Division of Gastroenterology, Northeast Alabama Regional Medical Center, Anniston, AL. ·Pancreas · Pubmed #30451795.

ABSTRACT: OBJECTIVES: Distinguishing neuroendocrine tumors (NETs) and other pancreas lesions from adenocarcinomas via endoscopic ultrasound (EUS) requires additional tissue for special staining and processing. Our aim was to determine if main pancreatic duct (PD) diameter on EUS helps to differentiate NET and other unusual tumors from adenocarcinoma. METHODS: We evaluated 30 consecutive patients diagnosed with NET or other pancreas lesions by EUS with 90 matched patients who were found to have adenocarcinoma. Dilated PD was defined as greater than 3 mm. Multivariate logistic regression was used to evaluate associations between lesion type and PD diameter. RESULTS: Among the 30 patients with NET/other pancreas lesions, 21 had NETs, 7 had metastases, and 2 had lymphomas. A dilated PD was demonstrated in only 3.3% of pancreatic NET/other lesions but present in 88.9% of cases of primary adenocarcinoma (P < 0.01). In multivariate analysis, a normal PD diameter and absence of clinical symptoms strongly predicted the presence of pancreatic NET/other versus adenocarcinoma (P < 0.01). CONCLUSIONS: The absence of PD dilation upstream of the lesion suggests NET or other lesions rather than adenocarcinoma. This finding should prompt endosonographers to obtain additional tissue at the time of EUS to send for special studies.

15 Article Primary pancreatic Hodgkin's lymphoma diagnosed on EUS-guided FNA. 2016

Mohamadnejad, Mehdi / Khosravi, Pejman / Khani, Mohsen / Nikmanesh, Arash / Eloubeidi, Mohamad A. ·Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran. · Division of Pathology, Tehran Gastroenterology and Hepatology Center, Tehran, Iran. · Department of Medicine, Division of Gastroenterology, American University of Beirut, Beirut, Lebanon. ·Gastrointest Endosc · Pubmed #26422973.

ABSTRACT: -- No abstract --

16 Article Lymph node ratio is an independent prognostic factor after resection of periampullary malignancies: data from a tertiary referral center in the middle East. 2014

Shamseddine, Ali I / Mukherji, Deborah / Melki, Christian / Elias, Elias / Eloubeidi, Mohammad / Dimassi, Hani / Khalife, Mohammad / Abou-Alfa, Ghassan / O'Reilly, Eileen / Faraj, Walid. ·*Department of Internal Medicine, Division of Hematology and Oncology †Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery ‡Department of Internal Medicine, Division of Gastroenterology, American University of Beirut, Beirut §Lebanese American University, School of Pharmacy, Byblos, Lebanon ∥Memorial Sloan-Kettering Cancer Center, Section of Gastrointestinal Oncology, New York, NY. ·Am J Clin Oncol · Pubmed #23111358.

ABSTRACT: OBJECTIVE: The prognostic impact of nodal involvement in resected pancreatic carcinoma and biliary malignancy has been relatively well established. It has been suggested that lymph node ratio (LNR) may be a more informative way of stratifying patients with node positive disease. Our retrospective review aimed to investigate the significance of such variables and test for independent prognostic factors for survival. METHODS: One hundred eighty-three pancreatic and periampullary malignancy cases were registered at the American University of Beirut Medical Center from 1990 to 2004. Of those, 80 had complete data on lymph node status. We analyzed the impact of the number of lymph nodes resected, the number of positive lymph nodes retrieved and LNR using Kaplan-Meier and Cox proportional hazard models. The measured outcome in the KM model was the survival probability at 1, 3, and 5 years while the Cox model was used to measure the hazard ratio (HR) of the previously identified predictors on survival. RESULTS: For the 80 patients included in this analysis, overall survival rates were 65% (54 to 78), 32% (18 to 47), and 21% (8 to 34) were alive at 1, 3, and 5 years, respectively. The median number of resected lymph nodes was 9. In the node positive patients, those who had >12 nodes examined were found to have a significantly better survival (HR=0.24; P=0.013). On multivariate analysis, our model showed the following factors to be significant: age 60 years or older (HR=5.92; P=0.018), poorly differentiated tumors (HR=21.87; P=0.018), number of lymph nodes examined <12 LN (HR=6.77; P=0.022), 3 or more metastatic LN (HR=7.21; P=0.028), and LNR≥0.2 (HR=7.12; P=0.007). CONCLUSIONS: After pancreaticodudonectomy for adenocarcinoma of the pancreas and biliary malignancies, ratio-based lymph node staging is an independent and powerful prognostic factor.

17 Article The presence of a cytopathologist increases the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration cytology for pancreatic adenocarcinoma: a meta-analysis. 2013

Hébert-Magee, S / Bae, S / Varadarajulu, S / Ramesh, J / Frost, A R / Eloubeidi, M A / Eltoum, I A. ·Division of Anatomic Pathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35249-6823, USA. shebertm@uab.edu ·Cytopathology · Pubmed #23711182.

ABSTRACT: OBJECTIVE: A meta-analysis has not been previously performed to evaluate critically the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of solely pancreatic ductal adenocarcinoma and address factors that have an impact on variability of accuracy. The aim of this study was to determine whether the presence of a cytopathologist, variability of the reference standard and other sources of heterogeneity significantly impacts diagnostic accuracy. METHODS: We conducted a comprehensive search to identify studies, in which the pooled sensitivity, specificity, likelihood ratios for a positive or negative test (LR+, LR-) and summary receiver-operating curves (SROC) could be determined for EUS-FNA of the pancreas for ductal adenocarcinoma using clinical follow-up, and/or surgical biopsy or excision as the reference standard. RESULTS: We included 34 distinct studies (3644 patients) in which EUS-FNA for a solid pancreatic mass was evaluated. The pooled sensitivity and specificity for EUS-FNA for pancreatic ductal adenocarcinoma was 88.6% [95% confidence interval (CI): 87.2-89.9] and 99.3% (95% CI: 98.7-99.7), respectively. The LR+ and LR- were 33.46 (95% CI: 20.76-53.91) and 0.11 (95% CI: 0.08-0.16), respectively. The meta-regression model showed rapid on-site evaluation (ROSE) (P = 0.001) remained a significant determinant of EUS-FNA accuracy after correcting for study population number and reference standard. CONCLUSION: EUS-FNA is an effective modality for diagnosing pancreatic ductal adencarcinoma in solid pancreatic lesions, with an increased diagnostic accuracy when using on-site cytopathology evaluation.

18 Article Endosonographic and cyst fluid characteristics of cystic pancreatic neuroendocrine tumours: a multicentre case series. 2013

Ho, Henry C / Eloubeidi, Mohamad A / Siddiqui, Uzma D / Brugge, William R / Rossi, Federico / Bounds, Brenna W / Aslanian, Harry R. ·Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA. Electronic address: henry.ho@yale.edu. ·Dig Liver Dis · Pubmed #23582348.

ABSTRACT: BACKGROUND: Pancreatic neuroendocrine tumours are uncommon neoplasms which may rarely be cystic. Differentiation from other more common cystic neoplasms may be difficult. AIMS: To describe the morphologic, cytologic, and cyst fluid characteristics of cystic pancreatic neuroendocrine tumours. METHODS: Retrospective analysis of consecutive patients referred for endosonographic evaluation of pancreatic cysts at four centres. RESULTS: 27 patients (12 males) with cystic pancreatic neuroendocrine tumours were identified. Prior to endosonography, this tumour was suspected in only 2 patients based on presenting symptoms (7.4%). The median cyst size was 35 mm (range 8-80 mm). Wall thickening was identified in 13 cases. The median carcinoembryonic antigen level was 1.25 (range 0.6-500). Fine needle aspiration cytology in 17 of 24 patients confirmed neuroendocrine tumour (71%). In 8 of 9 patients who had needle targeting of the cyst wall, cytology was consistent with neuroendocrine tumour (88.9%). 18 patients underwent surgical resection. CONCLUSIONS: Cystic pancreatic neuroendocrine tumour was rarely suspected, including by cross-sectional imaging. Wall thickening was identified in approximately half of cases on endosonography. Cyst fluid was typically non-viscous with very low carcinoembryonic antigen levels. Targeting the wall during fine needle aspiration had a high diagnostic yield and should be performed.

19 Article Intrapapillary mucinous tumor of the pancreas (with video). 2013

El Majzoub, Nadim W / Eloubeidi, Mohamad A. ·Department of Internal Medicine and the Division of Gastroenterology and Hepatology, The American University of Beirut Medical Center, Beirut, Lebanon. ·Gastrointest Endosc · Pubmed #23347751.

ABSTRACT: -- No abstract --

20 Article Patients with obstructive jaundice and biliary stricture ± mass lesion on imaging: prevalence of malignancy and potential role of EUS-FNA. 2013

Tummala, Pavan / Munigala, Satish / Eloubeidi, Mohamad A / Agarwal, Banke. ·Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St Louis, MO 63110, USA. ·J Clin Gastroenterol · Pubmed #23340062.

ABSTRACT: BACKGROUND: In patients with obstructive jaundice and biliary stricture, the role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is debated for fear of missing a potentially resectable pancreatobiliary malignancy (PBM). We evaluated the prevalence of (1) PBM; (2) lesions that do not require a potentially curative cancer surgery; and (3) potentially resectable PBMs in patients with false-negative diagnosis by EUS-FNA. PATIENTS AND METHODS: This is a retrospective analysis of 342 patients who underwent EUS/EUS-FNA from 2002 to 2009 after presenting with obstructive jaundice and a biliary stricture. Of these, 170 patients had no definitive mass on computed tomography and 172 patients had definitive mass on computed tomography without evidence of unresectability. Final diagnosis was based on surgical pathology or definitive cytology and clinical follow-up of ≥ 12 months. RESULTS: The mean age of patients (176 male) was 68.0±12.5 years. A final diagnosis of malignancy was made in only 248 patients (72.5%; 95% confidence interval, 67.7, 77.2). The overall accuracy of EUS-FNA for diagnosing malignancy was 92.4% (89.0, 94.8), with 91.5% sensitivity (87.1, 94.5) and 80.9% negative predictive value (72.0, 87.5). Among 21 patients with false-negative diagnosis, 8 had cholangiocarcinoma (2 resectable), 13 had pancreatic cancer (5 resectable). EUS-FNA provided information to potentially modify surgical management in 116 patients (33.9%; 95% confidence interval, 29.1, 39.0): 89 patients diagnosed as true negatives, 24 with distant malignant lymphadenopathy, and 3 with malignant lymphoma. CONCLUSIONS: In above-defined patient subset, the risk of missing resectable tumors by EUS-FNA has been exaggerated because of artifactually low negative predictive value resulting from a high pretest probability of PBM. The actual miss rate for resectable PBM by EUS-FNA is rather small and was 2% in present cohort. Information from EUS-FNA can potentially modify surgical management in up to one third of patients.

21 Article Ratio of pancreatic duct caliber to width of pancreatic gland by endosonography is predictive of pancreatic cancer. 2013

Eloubeidi, Mohamad A / Luz, Leticia P / Tamhane, Ashutosh / Khan, Mahboob / Buxbaum, James L. ·Department of Gastroenterology and Hepatology, University of Alabama in Birmingham, Birmingham, AL, USA. me75@aub.edu.lb ·Pancreas · Pubmed #23271395.

ABSTRACT: OBJECTIVES: This study aimed to determine whether (1) a pancreatic duct (PD) diameter to pancreatic gland width (G) ratio (PDG) by endoscopic ultrasonography (EUS) predicts pancreatic cancer (PC) and (2) whether this ratio better indicates PC compared to PD dilation alone. METHODS: Patients presenting for EUS were classified into the following 4 categories: (1) normal, (2) noncalcific chronic pancreatitis (NCCP), (3) calcific CP (CCP), and (4) PC. RESULTS: There were 198 patients enrolled. Final diagnoses were PC (n = 34), CCP (n = 16), and normal/NCCP (n = 148). The median PD diameter (8, 5, and 2 mm, respectively; P = <0.001), G (16, 20, and 17 mm, respectively; P = 0.002), and PDG ratio were significantly different among groups (0.54, 0.25, and 0.12, respectively; P < 0.001). Patients with PC were more likely to have a PDG ratio of greater than or equal to 0.34 compared to CCP, and normal/NCCP groups (94%, 19%, 1.3%, respectively; P < 0.001). The positive predictive value, negative predictive value, sensitivity, specificity, and accuracy of PDG greater than or equal to 0.34 for detecting cancer were 87%, 99%, 94%, 97%, and 97%, respectively. The accuracy and positive predictive value of PD dilation alone for diagnosing PC were 83% and 50%, respectively. CONCLUSIONS: A PDG ratio is a good predictor of PC and is better than PD dilation. This sign should be routinely used by endosonographers to improve EUS diagnostic capability of PC.

22 Article Utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of colorectal carcinoma. 2013

Knight, Carrie S / Eloubeidi, Mohamad A / Crowe, Ralph / Jhala, Nirag C / Jhala, Darshana N / Chhieng, David C / Eltoum, Isam A. ·Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama. ·Diagn Cytopathol · Pubmed #21932358.

ABSTRACT: The objective of this study is to assess the utility of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in the diagnosis and staging of colorectal cancer. The study includes patients who underwent EUS-FNA at our institution for staging of colorectal carcinoma or for evaluation peri-rectal masses or distal metastases from August 2000 to November 2010. We assessed the frequency with which EUS-FNA procedure confirms the diagnosis of malignancy and the percent of cases in which it modifies staging of colorectal carcinoma. Using histology as a reference standard, we also assessed the diagnostic performance. We identified 79 cases of EUS-FNA from 77 patients, mean (SD) age of 60 (12.5), 44 males. Twenty-seven (34%) aspirates were from patients with primary rectal/peri-rectal masses, 15 (19%) were from patients with suspected regional lymph node metastasis, and 37 (47%) were cases of suspected of distal metastasis. All lesions were clinically suspicious for primary or metastatic colorectal carcinoma. On cytologic examinations, 43 (54%) cases were confirmed as malignant, 6 (8%) were benign neoplasms, 4 (5%) were suspicious for malignant neoplasm, 2 (3%) showed atypical cells, and the rest 24 (30%) were negative for neoplasms. Fourteen of 27 (52%) of the local rectal masses were confirmed as colorectal carcinoma. Eleven of 15 (73%) regional lymph nodes were positive for metastasis-all, but two of these metastases, were of colorectal origin. Twenty of 37(54%) distal lesions were metastatic neoplasms and 15 of those were colorectal in origin. Diagnosis of primary colorectal carcinoma was confirmed in 52% of the clinically suspicious primary lesions and in 42% regional or distal metastatic lesions. Using histology as a reference standard in 27 of 79 (29%) cases, we calculated an overall sensitivity, specificity, and positive and negative predictive values (C.I) of EUS-FNA of 89% (74-100%), 79% (50-100%) 89% (74-100%), and 79% (51-100%). EUS-FNA is useful for assessing primary and metastatic colorectal lesion. This technique improves staging of suspected nodal or distant metastases.

23 Article Comparison of the influence of plastic and fully covered metal biliary stents on the accuracy of EUS-FNA for the diagnosis of pancreatic cancer. 2012

Siddiqui, Ali A / Fein, Michael / Kowalski, Thomas E / Loren, David E / Eloubeidi, Mohamad A. ·Division of Gastroenterology and Hepatology, Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA. ali.siddiqui@jefferson.edu ·Dig Dis Sci · Pubmed #22526586.

ABSTRACT: BACKGROUND AND STUDY AIMS: Prior studies have reported that the presence of prior biliary stent may interfere with EUS visualization of pancreatic tumors. We aimed to compare the influence of the biliary plastic and fully covered self-expanding metal stents (CSEMS) on the accuracy of EUS-FNA cytology in patients with solid pancreatic masses. PATIENTS AND METHODS: We conducted a retrospective study evaluating 677 patients with solid pancreatic head/uncinate lesions and a previous biliary stent in whom EUS-FNA was performed. The patients were stratified into two groups: (1) those with a plastic stents and (2) those with CSEMS. Performance characteristics of EUS-FNA including the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were compared between the two groups. RESULTS: The frequency of obtaining an adequate cytology by EUS-FNA was similar in both the CSEMS group and the plastic stent group (97 vs. 97.1 % respectively; p = 1.0). The sensitivity, specificity, and accuracy of EUS-FNA was not significantly different between patients with CSEMS and plastic stents (96.8, 100, 100 % and 97.3, 98, 99.8 %, respectively). The negative predictive value for EUS-FNA was lower in the CSEMS group compared to the plastic stent group (66.6 vs. 78.1 % respectively; p = 0.42). There was one false-positive cytology in the plastic stent group compared to none in the CSEMS group. CONCLUSIONS: In a retrospective cohort trial, EUS-FNA was found to be highly accurate and safe in diagnosing patients with suspected pancreatic cancer, even in the presence of a plastic or metallic biliary stent. The presence of a stent did not contribute to a higher false-positive cytology rate.

24 Article Oncocytic intraductal papillary mucinous neoplasm with carcinomatous degeneration. 2012

Buxbaum, James L / Jhala, Nirag C / Christein, John D / Eloubeidi, Mohamad A. ·Department of Gastroenterology, the University of Southern California, Los Angeles, California, USA. ·Gastrointest Endosc · Pubmed #22440204.

ABSTRACT: -- No abstract --

25 Article Unusual, metastatic, or neuroendocrine tumor of the pancreas: a diagnosis with endoscopic ultrasound-guided fine-needle aspiration and immunohistochemistry. 2012

Eloubeidi, Mohamad A / Tamhane, Ashutosh R / Buxbaum, James L. ·Department of Gastroenterology and Hepatology, University of Alabama in Birmingham, Birmingham Alabama, USA. me75@aub.edu.lb ·Saudi J Gastroenterol · Pubmed #22421714.

ABSTRACT: BACKGROUND/AIM: To determine the yield of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in combination with immunostains in diagnosing unusual solid pancreatic masses (USPM) in comparison with pancreatic adenocarcinoma (ACP). PATIENTS AND METHODS: All EUS-FNA of solid pancreatic masses performed with a 22-gauge needle were included. Data on clinical presentations, mass characteristics, presence of pancreatitis, yield of tissue, and final diagnosis were compared between the two groups. On site cytopathology was provided and additional passes were requested to perform immunostains. RESULTS: Two hundred and twenty-nine cases with either adenocarcinoma or USPM were included. The median age of the cohort was 65 years. ACP (210/229, 92%) accounted for the majority of the cases. The USPM included neuroendocrine (NET) masses (n=13), metastatic renal carcinoma (n=3), metastatic melanoma (n=1), lymphoma (n=1), and malignant fibrous histiocytoma (n=1). Subjects with ACP were significantly more likely to present with loss of weight (P=0.02) or obstructive jaundice (P<0.001). Subjects with ACP were more likely to have suspicious/atypical FNA biopsy results as compared with USPM (10% vs 0%). The sensitivity of EUS-FNA with immunostains was 93% in ACP as compared with 100% in USPM. Diagnostic accuracy was higher in USPM as compared with ACP (100% vs 93%). CONCLUSIONS: EUS-FNA using a 22-gauge needle with immunostains has excellent diagnostic yield in patients with USPMs, which is comparable if not superior to the yield in pancreatic adenocarcinoma.