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Pancreatic Neoplasms: HELP
Articles by Michael B. Wallace
Based on 26 articles published since 2008
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Between 2008 and 2019, M. B. Wallace wrote the following 26 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial Intraductal papillary mucinous neoplasms of the pancreas: should we side step the side branches? 2008

Bishop, Michele D / Wallace, Michael B. · ·Clin Gastroenterol Hepatol · Pubmed #18602034.

ABSTRACT: -- No abstract --

2 Review EUS and related technologies for the diagnosis and treatment of pancreatic disease: research gaps and opportunities-Summary of a National Institute of Diabetes and Digestive and Kidney Diseases workshop. 2017

Lee, Linda S / Andersen, Dana K / Ashida, Reiko / Brugge, William R / Canto, Mimi I / Chang, Kenneth J / Chari, Suresh T / DeWitt, John / Hwang, Joo Ha / Khashab, Mouen A / Kim, Kang / Levy, Michael J / McGrath, Kevin / Park, Walter G / Singhi, Aatur / Stevens, Tyler / Thompson, Christopher C / Topazian, Mark D / Wallace, Michael B / Wani, Sachin / Waxman, Irving / Yadav, Dhiraj / Singh, Vikesh K. ·Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. · Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA. · Departments of Cancer Survey and Gastrointestinal Oncology, Osaka Prefectural Hospital Organization, Osaka International Cancer Institute, Osaka, Japan. · Department of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA. · Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Comprehensive Digestive Disease Center, Department of Gastroenterology and Hepatology, University of California at Irvine Health, Orange, California, USA. · Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA. · Division of Gastroenterology, Indiana University Health Medical Center, Indianapolis, Indiana, USA. · Department of Medicine, University of Washington, Seattle, Washington, USA. · Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. · Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. · Department of Medicine, Stanford University School of Medicine, Stanford, California, USA. · Department of Pathology, University of Pittsburgh Medical Center, Sewickley, Pennsylvania, USA. · Department of Gastroenterology, Cleveland Clinic, Cleveland, Ohio, USA. · Department of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida, USA. · Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. · Department of Medicine, The University of Chicago Comprehensive Cancer Center, University of Chicago School of Medicine, Chicago, Illinois, USA. ·Gastrointest Endosc · Pubmed #28941651.

ABSTRACT: A workshop was sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases to address the research gaps and opportunities in pancreatic EUS. The event occurred on July 26, 2017 in 4 sessions: (1) benign pancreatic diseases, (2) high-risk pancreatic diseases, (3) diagnostic and therapeutics, and (4) new technologies. The current state of knowledge was reviewed, with identification of numerous gaps in knowledge and research needs. Common themes included the need for large multicenter consortia of various pancreatic diseases to facilitate meaningful research of these entities; to standardize EUS features of different pancreatic disorders, the technique of sampling pancreatic lesions, and the performance of various therapeutic EUS procedures; and to identify high-risk disease early at the cellular level before macroscopic disease develops. The need for specialized tools and accessories to enable the safe and effective performance of therapeutic EUS procedures also was discussed.

3 Review Intraductal papillary mucinous neoplasms and mucinous cystadenomas: current status and recommendations. 2017

Moris, Maria / Wallace, Michael B. ·Gastroenterology, Mayo Clinic, Canadá. · Gastroenterology, Mayo Clinic, USA. ·Rev Esp Enferm Dig · Pubmed #28112959.

ABSTRACT: The real prevalence of pancreatic cystic lesions remains unknown. The malignant potential of some of these lesions remains a cause for significant concern. Thus, it is mandatory to develop a strategy to clearly discriminate those cysts with a potential for malignant transformation from those that do not carry any significant risk. Intraductal papillary mucinous neoplasms and mucinous cystadenomas are mucinous cystic neoplasms with a known malignant potential that have gained greater recognition in recent years. However, despite the numerous studies that have been carried out, their differential diagnosis among other cysts subtypes and their therapeutic approach continue to be a challenge for clinicians. This review contains a critical approach of the current recommendations and management strategies regarding intraductal papillary mucinous neoplasms and mucinous cystadenomas, as well as highlighting the limitations exposed in current guidelines.

4 Review Quality indicators for EUS. 2015

Wani, Sachin / Wallace, Michael B / Cohen, Jonathan / Pike, Irving M / Adler, Douglas G / Kochman, Michael L / Lieb, John G / Park, Walter G / Rizk, Maged K / Sawhney, Mandeep S / Shaheen, Nicholas J / Tokar, Jeffrey L. · ·Gastrointest Endosc · Pubmed #25480097.

ABSTRACT: -- No abstract --

5 Review The role of endoscopic ultrasonography in the diagnosis and management of pancreatic cancer. 2012

Othman, Mohamed O / Wallace, Michael B. ·Division of Gastroenterology, Department of Internal Medicine, Texas Tech HSC at El Paso, El Paso, TX 79905, USA. ·Gastroenterol Clin North Am · Pubmed #22341257.

ABSTRACT: EUS with FNA is highly sensitive and specific for diagnosing pancreatic cancer. However, in certain situations, such as in patients with chronic pancreatitis, this high sensitivity and specificity can significantly diminish. The use of new technology, such as EUS elastography, CE-EUS, and gene mutations detection in FNA specimens, can help to differentiate chronic pancreatitis from pancreatic cancer. EUS has evolved from a diagnostic procedure to a therapeutic intervention in pancreatic cancer. EUS-guided fiducial insertion and EUS-guided delivery of antitumor agents, in addition to celiac plexus neurolysis, are the main therapeutic applications of EUS in pancreatic cancer.

6 Article Volumetric laser endomicroscopy in the biliary and pancreatic ducts: a feasibility study with histological correlation. 2018

Corral, Juan E / Mousa, Omar Y / Krishna, Murli / Levink, Iris J M / Pursell, Khela R / Afsh, Mohammad / Kröner, Paul T / Harnois, Denise M / Wolfsen, Herbert C / Wallace, Michael B / Lukens, Frank J. ·Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA. · Division of Pathology, Mayo Clinic, Jacksonville, Florida, USA. · Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands. ·Endoscopy · Pubmed #29913531.

ABSTRACT: BACKGROUND: Volumetric laser endomicroscopy (VLE) provides circumferential images 3 mm into the biliary and pancreatic ducts. We aimed to correlate VLE images with the normal and abnormal microstructure of these ducts. METHODS: Samples from patients undergoing hepatic or pancreatic resection were evaluated. VLE images were collected using a low-profile VLE catheter inserted manually into the biliary and pancreatic ducts ex vivo. Histological correlation was assessed by two unblinded investigators. RESULTS: 25 patients (20 liver and 5 pancreatic samples) and 111 images were analyzed. VLE revealed three histological layers: epithelium, connective tissue, and parenchyma. It identified distinctive patterns for primary sclerosing cholangitis (PSC), pancreatic cysts, neuroendocrine tumor, and adenocarcinoma adjacent to the pancreatic duct or ampulla. VLE failed to identify dysplasia in a dominant stricture and inflammatory infiltrates in PSC. Reflectivity measurements of the liver parenchyma diagnosed liver cirrhosis with high sensitivity. CONCLUSIONS: VLE can identify histological changes in the biliary and pancreatic ducts allowing real-time diagnosis. Further studies are needed to measure the accuracy of VLE in a larger sample and to validate our findings in vivo.

7 Article Predictors of Progression Among Low-Risk Intraductal Papillary Mucinous Neoplasms in a Multicenter Surveillance Cohort. 2018

Gausman, Valerie / Kandel, Pujan / Van Riet, Priscilla A / Moris, Maria / Kayal, Maia / Do, Catherine / Poneros, John M / Sethi, Amrita / Gress, Frank G / Schrope, Beth A / Luk, Lyndon / Hecht, Elizabeth / Jovani, Manol / Bruno, Marco J / Cahen, Djuna L / Wallace, Michael B / Gonda, Tamas A. · ·Pancreas · Pubmed #29521942.

ABSTRACT: OBJECTIVES: Our aim was to identify baseline characteristics associated with disease progression and malignant transformation in low-risk suspected intraductal papillary mucinous neoplasms (IPMNs). METHODS: This is a retrospective cohort study of prospectively maintained databases of pancreatic cysts at 3 international, academic institutions. Five hundred fifty-nine adult patients with clinically suspected asymptomatic IPMN evaluated by radiologic studies or endoscopic ultrasound between 2003 and 2013 without worrisome features and under surveillance for 12 months or longer were included. We evaluated the relationship of baseline demographics and cyst features to disease progression (size increase, development of worrisome features, or high-grade dysplasia/cancer). RESULTS: After a median of 44 months follow-up, 269 (48%) patients experienced cyst size increase, 68 (12%) developed worrisome features, and 11 (2%) developed high-grade dysplasia/cancer. In multivariable Cox-regression analysis, no baseline characteristics were associated with size increase. An initial cyst size of 2 cm or greater, multifocality, history of prostate cancer, and smoking were the strongest predictors of development of new worrisome features. Univariable analysis found male sex, diabetes, and recent weight loss associated with development of high-grade dysplasia/cancer. CONCLUSIONS: Our study demonstrates that low-risk suspected IPMNs carry a small but clinically relevant risk of disease progression and provides data on baseline characteristics that may help in risk stratification.

8 Article International Intraductal Papillary Mucinous Neoplasms Registry: Long-Term Results Based on the New Guidelines. 2017

Moris, Maria / Raimondo, Massimo / Woodward, Timothy A / Skinner, Verna J / Arcidiacono, Paolo G / Petrone, Maria C / De Angelis, Claudio / Manfrè, Selene / Carrara, Silvia / Jovani, Manol / Fusaroli, Pietro / Wallace, Michael B. ·From the *Department of Gastroenterology and †Clinical Studies Unit, Mayo Clinic, Jacksonville, FL; ‡Department of Gastroenterology, San Raffaele Scientific Institute, Milan; §Department of Gastroenterology, Azienda Universitario-Ospedaliera San Giovanni Battista, Turin; ∥Department of Gastroenterology, Humanitas Research Hospital, Milan; and ¶Department of Gastroenterology, University of Bologna/Hospital of Imola, Italy. ·Pancreas · Pubmed #28099263.

ABSTRACT: OBJECTIVE: The aim of this study was to analyze the outcomes of a long-term intraductal papillary mucinous neoplasm (IPMN) registry and evaluate new guidelines. METHODS: A prospectively maintained IPMN registry involving 6 centers in Europe and the United States was used to collect the data. Patients with more than 1-year follow-up and no malignancy diagnosed within the first 3 months of surveillance were included. RESULTS: From 1999 to 2014, 620 patients were included. The median follow-up time was 3 years. Thirty-seven (6%) patients developed malignancy with a median time from IPMN diagnosis to malignancy of 10.3 months. The 1-, 5-, and 10-year actuarial rates of disease-free survival were 97%, 93%, and 92% respectively. Four hundred thirty-one patients met criteria for low-risk branch duct IPMN consisting of cyst size less than 3 cm, with no solid component or main duct dilation. Eight malignancies were diagnosed in this subgroup, all of them within the first 5 years. From this subcohort, 112 patients had a follow-up time of more than 5 years, and no malignancy was diagnosed. CONCLUSIONS: In IPMN lesions with low-risk features at baseline, the risk of progression to malignancy after the first 5 years of follow-up was minimal. Furthermore, the main cyst characteristics remained unchanged during their surveillance.

9 Article Plectin-1 as a Biomarker of Malignant Progression in Intraductal Papillary Mucinous Neoplasms: A Multicenter Study. 2016

Moris, Maria / Dawson, David W / Jiang, Jennifer / Lewis, Jason / Nassar, Aziza / Takeuchi, Kenneth K / Lay, Anna R / Zhai, Qihui / Donahue, Timothy R / Kelly, Kimberly A / Crawford, Howard C / Wallace, Michael. ·From the *Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL; †Department of Pathology and Laboratory Medicine and Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, CA; Departments of ‡Pathology and Laboratory Medicine, and §Cancer Biology, Mayo Clinic, Jacksonville, FL; ∥Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA; and ¶Department of Bioengineering, School of Engineering and Applied Sciences, and #Robert M. Berne Cardiovasuclar Research Center, School of Medicine, University of Virginia, Charlottesville, VA. ·Pancreas · Pubmed #27101571.

ABSTRACT: OBJECTIVE: This study aimed to evaluate Plectin-1 expression as a biomarker of malignant risk for intraductal papillary mucinous neoplasms (IPMNs). METHODS: Plectin-1 immunohistochemistry (IHC) was performed retrospectively on surgical (n = 71) and cytological (n = 33) specimens from Mayo Clinic Jacksonville and UCLA Medical Center, including IPMNs with low-grade dysplasia, high-grade dysplasia (HGD), or an associated invasive adenocarcinoma. RESULTS: Plectin-1 expression was increased in invasive adenocarcinoma compared with adjacent in situ IPMN (P = 0.005), as well as the in situ HGD component of IPMNs with invasive cancer compared with HGD of IPMNs without invasive cancer (P = 0.02). Plectin IHC discriminated IPMNs with invasive adenocarcinoma from noninvasive IPMN (area under the curve [AUC] of 0.79, 75% sensitivity, and 85% specificity) but was insufficient for discriminating HGD IPMN from low-grade dysplasia IPMNs in surgical resections (AUC of 0.67, 56% sensitivity, and 64% specificity) or fine-needle aspiration specimens (AUC of 0.45). CONCLUSIONS: Although Plectin-1 IHC has insufficient accuracy to be used as a definitive biomarker for malignant risk in the evaluation of IPMN biopsy or cytological specimens, increased Plectin-1 expression observed in both invasive cancer and in situ HGD of malignant IPMNs suggests that it might be successfully leveraged as a cyst fluid biomarker or molecular imaging target.

10 Article Diagnostic Accuracy of Endoscopic Ultrasound-Guided Fine-Needle Aspiration Cytology, Carcinoembryonic Antigen, and Amylase in Intraductal Papillary Mucinous Neoplasm. 2016

Moris, Maria / Raimondo, Massimo / Woodward, Timothy A / Skinner, Verna / Arcidiacono, Paolo G / Petrone, Maria C / De Angelis, Claudio / Manfrè, Selene / Fusaroli, Pietro / Asbun, Horacio / Stauffer, John / Wallace, Michael B. ·From the *Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL; †Programa de Doctorat en Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain; ‡San Raffaele Scientific Institute, Milano, Italy; §Azienda Universitario-Ospedaliera San Giovanni Battista, Torino, Italy; ∥University of Bologna/Hospital of Imola, Imola, Italy; and ¶Department of Surgery, Mayo Clinic, Jacksonville, FL. ·Pancreas · Pubmed #26646270.

ABSTRACT: OBJECTIVES: The aim of this study was to determine the accuracy of cytology, carcinoembryonic antigen (CEA), and amylase levels in the preoperative diagnosis of intraductal papillary mucinous neoplasms (IPMNs). METHODS: An international registry was started in 2005 and included patients with clinically suspected IPMNs. Those who underwent surgery and had preoperative endoscopic ultrasonography fine-needle aspiration were selected for the study. RESULTS: One hundred eighty patients were included. Cytological analysis for neoplastic cells in IPMNs showed high specificity (87.8%) but low sensitivity (39.4%). The median CEA level was 525.5 ng/mL (n = 78) in IPMNs versus 9.7 ng/mL in nonmucinous cysts (n = 6), showing an area under the receiver operating characteristic curve (AUC) of 0.87. The optimal cutoff CEA value for distinguishing IPMN from nonmucinous cysts was 129 ng/mL. At this level, the sensitivity was 76.9%, and specificity was 83.3%, yielding a positive predictive value of 95.9% and a negative predictive value of 41.9%. Carcinoembryonic antigen was a poor predictor of neoplasia in IPMNs (AUC = 0.55). Amylase did not distinguish IPMNs from mucinous cystadenomas (MCAs) (median, 3759 U/L [n = 28 IPMNs] and 497 U/L [n = 3 MCAs], AUC = 0.65). CONCLUSIONS: Cytology has a limited role because of its lack of sensitivity. Carcinoembryonic antigen modestly differentiated between mucinous and nonmucinous lesions. Amylase did not distinguish IPMNs versus MCAs.

11 Article Risk factors for malignant progression of intraductal papillary mucinous neoplasms. 2015

Moris, Maria / Raimondo, Massimo / Woodward, Timothy A / Skinner, Verna / Arcidiacono, Paolo G / Petrone, Maria C / De Angelis, Claudio / Manfrè, Selene / Fusaroli, Pietro / Wallace, Michael B. ·Mayo Clinic, Jacksonville, FL, USA; Programa de Doctorat en Medicina de la Universitat Autònoma de Barcelona, Barcelona, Spain. · Mayo Clinic, Jacksonville, FL, USA. · San Raffaele Scientific Institute, Milano, Italy. · Azienda Universitario-Ospedaliera San Giovanni Battista, Torino, Italy. · University of Bologna/Hospital of Imola, Imola, Italy. · Mayo Clinic, Jacksonville, FL, USA. Electronic address: Wallace.michael@mayo.edu. ·Dig Liver Dis · Pubmed #25869552.

ABSTRACT: BACKGROUND: Intraductal papillary mucinous neoplasms of the pancreas are increasingly diagnosed. Due to their malignant potential, greater understanding of their nature is required. AIMS: Define risk factors for malignancy in intraductal papillary mucinous neoplasms. METHODS: An international, multicentre study was performed in Europe and the United States. Clinical databases were reviewed for patients with intraductal papillary mucinous neoplasms diagnosis. RESULTS: Of 1126 patients, 84 were diagnosed with invasive carcinoma/high-grade dysplasia and were compared to the rest of the cohort. Multivariate logistic analysis showed a statistically significant association between cancer/high-grade dysplasia and the variables smoking history (OR 1.9, 95% CI [1.1-3.1]), body mass index (OR 1.1, 95% CI [1-1.1]), symptoms (OR 3.4, 95% CI [1.9-6]), jaundice (OR 0.1, 95% CI [0-0.3]), and steatorrhea (OR 0.3, 95% CI [0.1-0.8]). Univariate analysis showed no association between malignancy and the cyst number/location (p=0.3 and p=0.5, respectively) although a strong association was shown for cyst size (p<0.001). The presence and size of nodules (p<0.01) and main duct involvement (p<0.001) were also strongly related with malignancy. CONCLUSION: The presence of jaundice and steatorrhea, smoking, high body mass index, and imaging features such as cyst size, main duct involvement, and the presence and size of mural nodules are associated with high-grade neoplasia in intraductal papillary mucinous neoplasms.

12 Article Preoperative endoscopic ultrasound-guided fine needle aspiration does not impair survival of patients with resected pancreatic cancer. 2015

Ngamruengphong, Saowanee / Swanson, Kristi M / Shah, Nilay D / Wallace, Michael B. ·Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA. · Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA. ·Gut · Pubmed #25575893.

ABSTRACT: OBJECTIVE: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) allows preoperative tissue confirmation of malignancy, but fear of tumour cell dissemination along the needle track has limited its use. We hypothesised that if tumour cell dissemination occurs with EUS-FNA, survival after complete resection would be impaired. We aimed to evaluate the association of preoperative EUS-FNA with long-term outcomes of patients with resected pancreatic cancer. DESIGN: Using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified patients with locoregional pancreatic cancer who underwent curative intent surgery from 1998 to 2009. The patients who received EUS-FNA within the peridiagnostic period were included in the EUS-FNA group. Patients who did not receive EUS evaluation or who underwent EUS without FNA were included in the non-EUS-FNA group. Overall survival and pancreatic cancer-specific survival were compared after controlling for relevant covariates. RESULTS: A total of 2034 patients with pancreatic cancer were included (90% pancreatic adenocarcinoma). Of these, 498 (24%) patients were in EUS-FNA group. Patients with multiple comorbidities and more recent diagnosis were more likely to receive EUS-FNA. In multivariate analysis, after controlling for age, race, gender, tumour histology, tumour stage, tumour grade, tumour location, SEER site, year of diagnosis, undergoing percutaneous aspiration/biopsy, Charlson Comorbidity Index, radiation and chemotherapy, EUS-FNA was marginally associated with improved overall survival (HR 0.84, 95% CI 0.72 to 0.99), but did not affect cancer-specific survival (HR 0.87, 95% CI 0.74 to 1.03). CONCLUSIONS: Preoperative EUS-FNA was not associated with increased risk of mortality. These data suggest that EUS-FNA can be safely performed for the work-up of suspicious pancreatic lesions.

13 Article Polarization gating spectroscopy of normal-appearing duodenal mucosa to detect pancreatic cancer. 2014

Patel, Mihir / Gomes, Andrew / Ruderman, Sarah / Hardee, Darla / Crespo, Sergio / Raimondo, Massimo / Woodward, Timothy / Backman, Vadim / Roy, Hemant / Wallace, Michael. ·Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA. · Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA. · Department of Gastroenterology, Boston University Medical Center, Boston, Massachusetts, USA. ·Gastrointest Endosc · Pubmed #24861243.

ABSTRACT: BACKGROUND: According to the field effect theory, by detecting microvasculature changes such as early increase in blood supply (EIBS) in the surrounding tissue, neoplastic lesions can be identified from a distance. OBJECTIVE: To determine the feasibility and efficacy of a fiberoptic probe containing novel polarization gating spectroscopy technology to identify patients with pancreatic adenocarcinoma (PAC) by the field effect theory. DESIGN: Prospective cohort (pilot) study. SETTING: Outpatient tertiary care center. PATIENTS: Adult (≥ 18 years) patients undergoing EGD-EUS were screened. Patients with PAC were included in the "cancer" group and patients without PAC were included in the "control" group. We excluded patients with other known malignancies and gastroduodenal premalignant lesions. INTERVENTIONS AND MAIN OUTCOME MEASURES: Spectroscopic measurements of EIBS variables, such as deoxyhemoglobin concentration (DHb) and mean blood vessel radius (BVR), were obtained from 5 periampullary locations. The Mann-Whitney rank sum test was used for the statistical analysis (P ≤ .05). RESULTS: Fourteen patients (mean age 72 years, 79% male) in the cancer group and 15 patients (mean age 63 years, 60% male) in the control group were included in the final analysis. At the ampullary site, both DHb (P = .001) and BVR (P = .03) were higher in PAC patients than in the control subjects. The DHb alone (92% sensitivity, 86% specificity) or in combination with BVR (92% sensitivity, 79% specificity) can differentiate PAC from control subjects with high accuracy. LIMITATIONS: Small sample size, unmatched control subjects. CONCLUSIONS: Spectroscopic measurements of EIBS by fiberoptic probes are feasible. Preliminary evidence suggests that in vivo measurement of normal-appearing duodenal tissue can differentiate PAC patients from a distance with high accuracy.

14 Article ZIP4 is a novel diagnostic and prognostic marker in human pancreatic cancer: a systemic comparison between EUS-FNA and surgical specimens. 2014

Xu, C / Wallace, M B / Yang, J / Jiang, L / Zhai, Q / Zhang, Y / Hong, C / Chen, Y / Frank, T S / Stauffer, J A / Asbun, H J / Raimondo, M / Woodward, T A / Li, Z / Guha, S / Zheng, L / Li, M. ·Vivian L. Smith Department of Neurosurgery, the University of Texas Medical School at Houston, 6431 Fannin Street, MSE R131, Houston, TX 77030, USA. min.li@uth.tmc.edu. ·Curr Mol Med · Pubmed #24345208.

ABSTRACT: Aberrant expression of a zinc transporter ZIP4 in pancreatic ductal adenocarcinoma (PDAC) has been shown to contribute to tumor progression and is a potential target for individualized therapy. The overall objective of this study was to determine whether ZIP4 could serve as a novel diagnostic and prognostic marker in human PDAC, and if it can be assessed by minimally invasive sampling using endoscopic ultrasound guided fine needle aspiration (EUS-FNA). Immunohistochemistry was performed to compare ZIP4 expression in the PDAC samples obtained from EUS-FNA and matched surgical tumors (parallel control). Samples were reported by sensitivity, specificity, and predictive values, all with 95% confidence intervals (CI). A total of 23 cases with both FNA and surgical specimens were evaluated. We found that ZIP4 was significantly overexpressed in tumor cells from both sets of samples. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ZIP4 for the diagnosis of PDAC were 72.9%, 72.5%, 76.1%, and 69.0% in EUS-FNA samples, and were 97.9%, 65.4%, 83.9%, and 94.4% in surgical specimens, respectively. The association between the positive rate of ZIP4 expression in FNA and surgical samples is statistically significant (P=0.0216). Both the intensity and percentage of ZIP4 positive cells from the surgical samples correlated significantly with tumor stage (P=0.0025 and P=0.0002). ZIP4 intensity level in FNA samples was significantly associated with tumor differentiation and patient survival. These results indicate that EUS-FNA is capable of non-operative detection of ZIP4, thus offering the potential to direct pre-operative detection and targeted therapy of PDAC.

15 Article A pilot study of in vivo identification of pancreatic cystic neoplasms with needle-based confocal laser endomicroscopy under endosonographic guidance. 2013

Konda, Vani J A / Meining, Alexander / Jamil, Laith H / Giovannini, Marc / Hwang, Joo Ha / Wallace, Michael B / Chang, Kenneth J / Siddiqui, Uzma D / Hart, John / Lo, Simon K / Saunders, Michael D / Aslanian, Harry R / Wroblewski, Kirsten / Waxman, Irving. ·Center for Endoscopic Research and Therapeutics, Section of Gastroenterology, University of Chicago Medicine, Chicago, Illinois, USA. ·Endoscopy · Pubmed #24163192.

ABSTRACT: BACKGROUND AND STUDY AIMS: Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) of pancreatic cystic lesions (PCL) is flawed by inadequate diagnostic yield. Needle-based confocal laser endomicroscopy (nCLE) utilizes a sub-millimeter probe that is compatible with an EUS needle and enables real-time imaging with microscopic detail of PCL. The aims of the In vivo nCLE Study in the Pancreas with Endosonography of Cystic Tumors (INSPECT) pilot study were to assess both the diagnostic potential of nCLE in differentiating cyst types and the safety of the technique. PATIENTS AND METHODS: Eight referral centers performed nCLE in patients with PCL. Stage 1 defined descriptive terms for structures visualized by an off-line, unblinded consensus review. Cases were reviewed with a gastrointestinal pathologist to identify correlations between histology and nCLE. Stage 2 assessed whether the specific criteria defined in Stage 1 could identify pancreatic cystic neoplasms (PCN) including intraductal papillary mucinous neoplasms, mucinous cystic adenoma, or adenocarcinoma in an off-line blinded consensus review. RESULTS: A total of 66 patients underwent nCLE imaging and images were available for 65, 8 of which were subsequently excluded due to insufficient information for consensus reference diagnosis. The presence of epithelial villous structures based on nCLE was associated with PCN (P=0.004) and provided a sensitivity of 59%, specificity of 100%, positive predictive value of 100 %, and negative predictive value of 50%. The overall complication rate was 9% and included pancreatitis (1 mild case, 1 moderate case), transient abdominal pain (n=1), and intracystic bleeding not requiring any further measures (n=3). CONCLUSIONS: These preliminary data suggested that nCLE has a high specificity in the detection of PCN, but may be limited by a low sensitivity. The safety of nCLE requires further evaluation.

16 Article Risk of gastric or peritoneal recurrence, and long-term outcomes, following pancreatic cancer resection with preoperative endosonographically guided fine needle aspiration. 2013

Ngamruengphong, S / Xu, C / Woodward, T A / Raimondo, M / Stauffer, J A / Asbun, H J / Wallace, M B. ·Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, Florida, USA. ·Endoscopy · Pubmed #23881804.

ABSTRACT: BACKGROUND AND STUDY AIMS: There have been concerns regarding tumor cell seeding along the needle track or within the peritoneum caused by preoperative endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The aim of this study was to evaluate whether preoperative EUS-FNA is associated with increased risk of stomach/peritoneal recurrence and whether the procedure affects long term survival. METHODS: The records of patients diagnosed with malignant solid and cystic pancreatic neoplasms who underwent surgery with curative intent between 1996 and 2012 were reviewed. RESULTS: A total of 256 patients with similar baseline characteristics were included: 48 patients in the non-EUS-FNA group and 208 in the EUS-FNA group. Recurrence data were available for 207 patients. Median length of follow-up was 23 months (range 0 - 111 months). A total of 19 patients had gastric or peritoneal recurrence; 6 (15.4 %) in the non-EUS-FNA group vs. 13 (7.7 %) in the EUS-FNA group (P = 0.21). Three patients had recurrence in the stomach wall: one (2.6 %) patient in the non-EUS-FNA group vs. two patients (1.2 %) in EUS-FNA group (P = 0.46). A total of 16 patients had peritoneal recurrence: 5 patients (12.8 %) in the non-EUS-FNA group and 11 patients (6.5 %) in the EUS-FNA group (P = 0.19). In a multivariate analysis, undergoing EUS-FNA was not associated with increased cancer recurrence or decreased overall survival. CONCLUSION: Pre-operative EUS-FNA was not associated with an increased rate of gastric or peritoneal cancer recurrence in patients with resected pancreatic cancer. Two patients had gastric wall recurrence following the procedure, but this may be explained by direct tumor extension. This suggests that EUS-FNA is not associated with an increased risk of needle track seeding.

17 Article Neutrophil gelatinase-associated lipocalin, macrophage inhibitory cytokine 1, and carbohydrate antigen 19-9 in pancreatic juice: pathobiologic implications in diagnosing benign and malignant disease of the pancreas. 2013

Kaur, Sukhwinder / Baine, Michael J / Guha, Sushovan / Ochi, Nobuo / Chakraborty, Subhankar / Mallya, Kavita / Thomas, Colleen / Crook, Julia / Wallace, Michael B / Woodward, Timothy A / Jain, Maneesh / Singh, Shailender / Sasson, Aaron R / Skinner, Verna / Raimondo, Massimo / Batra, Surinder K. ·Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA. ·Pancreas · Pubmed #23146921.

ABSTRACT: OBJECTIVE: Pancreatic diseases pose significant diagnostic challenge as signs and symptoms often overlap. We investigated the potential of pancreatic juice neutrophil gelatinase-associated lipocalin, macrophage inhibitory cytokine 1 (MIC-1), and carbohydrate antigen 19-9 (CA19-9) to aid in the diagnosis of patients with symptoms suggestive of pancreatic diseases. METHODS: A total of 105 chronic pancreatitis (CP), pancreatic cancer (PC), and nonpancreatic nonhealthy (patients with symptoms mimicking pancreatic disease but found to be free of any pancreatic disease) patients underwent endoscopic pancreatic juice collection after secretin stimulation. Neutrophil gelatinase-associated lipocalin and MIC-1 levels were measured by enzyme-linked immunosorbent assay, whereas CA19-9 was measured by radioimmunoassay. RESULTS: Neutrophil gelatinase-associated lipocalin, MIC-1, and CA19-9 were significantly elevated in the pancreatic juice of patients with CP and patients with PC as compared with nonpancreatic nonhealthy controls (P ≤ 0.034). Neutrophil gelatinase-associated lipocalin seemed most promising in differentiating diseased versus nondiseased pancreata (areas under the curve, 0.88-0.91), whereas MIC-1 was found to be higher in patients with PC than in patients with CP (P = 0.043). Interestingly, MIC-1 levels in diabetic patients with PC were higher than in nondiabetic patients with PC (P = 0.030) and diabetic patients with CP (P = 0.087). Carbohydrate antigen 19-9 showed the least ability to distinguish patient groups (areas under the curve, 0.61-0.76). CONCLUSIONS: Pancreatic juice neutrophil gelatinase-associated lipocalin shows potential utility in establishing pancreatic etiology in the context of nonspecific symptoms, whereas MIC-1 may aid in differentiating PC from CP.

18 Article What extent of pancreatic resection do patients with MEN-1 require? 2012

Adkisson, Cameron D / Stauffer, John A / Bowers, Steven P / Raimondo, Massimo / Wallace, Michael B / Riegert-Johnson, Douglas L / Asbun, Horacio J. ·Department of General Surgery, Mayo Clinic Florida, Jacksonville, FL 32224, USA. ·JOP · Pubmed #22797396.

ABSTRACT: CONTEXT: The surgical management of pancreatic endocrine tumors in patients with multiple endocrine neoplasia type 1 (MEN-1) is controversial and complicated by the fact that these tumors are frequently multifocal. The degree of tumor resection is determined by weighing the risk of malignancy or tumor recurrence against the risks of endocrine/exocrine insufficiency with complete gland removal. METHODS: A retrospective review was performed identifying 4 patients with MEN-1 and pancreatic endocrine tumors treated with pancreatic resection over a 2-year period at our institution. RESULTS: Mean age at operation was 35 years. Surgical approach was determined by size of tumor(s) and presence of multifocality. MRI and EUS were performed in all patients. While EUS identified a greater number of tumors when compared to MRI (median 5 versus 1), both studies grossly underestimated the total number of tumors found on final pathology. Three patients underwent laparoscopic total pancreatectomy for multifocal disease with diffuse pancreatic involvement, finding a median of 12 tumors. One patient underwent laparoscopic subtotal pancreatectomy for a presumed single pancreatic tail mass, but was found to have multifocal disease on final pathology consisting of 7 tumors. The average number of tumors found on final pathology was 13.5 with an average size of 2.6 cm. The median number of lymph nodes analyzed was 14. Diffuse, multifocal disease was present in all 4 patients. No major postoperative complications were observed. CONCLUSION: In patients with MEN-1 and pancreatic endocrine tumors, preoperative workup underestimates extent of disease and total pancreatectomy should be considered for complete tumor removal.

19 Article Carcino Embryonic Antigen and long-term follow-up of mucinous pancreatic cysts including intraductal papillary mucinous neoplasm. 2012

Othman, Mohamed O / Patel, Mihir / Dabizzi, Emanuele / Asbun, Horacio J / Stauffer, John / Wallace, Michael B / Woodward, Timothy A / Raimondo, Massimo. ·Department of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, FL, United States. ·Dig Liver Dis · Pubmed #22789399.

ABSTRACT: BACKGROUND AND AIMS: The utility of Carcino Embryonic Antigen (CEA) in differentiating malignant from benign pancreatic cysts is controversial. We sought to examine the role of CEA in differentiating benign from malignant cysts and its utility in progression of cyst size in follow-up. METHODS: Retrospective chart review of patients who underwent Endoscopic Ultrasound with Fine Needle Aspiration for mucinous cysts between 1998 and 2010. CEA was measured in benign and malignant mucinous cysts. Coefficient of determination (R(2)) was used to measure the association between change in cyst size and CEA. Mann-Whitney test was used to compare the median values of CEA. RESULTS: 143 patients (38.4% males) were included (mean age 68.9 ± 0.8 years). 105 patients had intra-cystic CEA measured. 63 patients underwent surgery while 80 patients were in the follow-up group. In the surgical group, median CEA value for benign and malignant mucinous neoplasms was 796 and 438 ng/ml, respectively (p=0.79). The median follow-up was 21 months. There was no correlation between CEA level and progression in cyst size in patients who had >6 months of follow-up, R(2)=0.0002. Malignant transformation was observed in 5 (5.9%) patients. CONCLUSION: CEA level was not predictive of malignant cyst nor cyst size progression over follow-up.

20 Article First assessment of needle-based confocal laser endomicroscopy during EUS-FNA procedures of the pancreas (with videos). 2011

Konda, Vani J A / Aslanian, Harry R / Wallace, Michael B / Siddiqui, Uzma D / Hart, John / Waxman, Irving. ·Center for Endoscopic Research and Therapeutics, Section of Gastroenterology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois 60637, USA. ·Gastrointest Endosc · Pubmed #21924718.

ABSTRACT: BACKGROUND: Challenges in EUS-guided FNA (EUS-FNA) include sampling error, nondiagnostic cytology, and limited on-site cytological evaluation. A prototype needle-based confocal laser endomicroscopy (nCLE) probe is a submillimeter probe that provides real-time imaging at the microscopic level through the FNA needle. OBJECTIVE: To evaluate the feasibility of nCLE during EUS-FNA of pancreatic lesions. DESIGN: Feasibility study. SETTING: Multicenter, tertiary care. PATIENTS: Eighteen patients presenting for EUS-FNA. INTERVENTIONS: Patients were injected with 2.5 mL of 10% fluorescein. The lesion was interrogated with the nCLE probe positioned at the tip of a 19-gauge FNA needle. MAIN OUTCOME MEASUREMENTS: Device integrity, technical ease, safety, and image acquisition. RESULTS: Cases included 16 cysts and 2 masses. There were no device malfunctions. Technical challenges were encountered in 6 of 18 attempts to image and reflected challenges with a postloading technique, the longer ferule tip, and a transduodenal approach. Technical feasibility to perform imaging with nCLE during a pancreatic EUS-FNA procedure was achieved in 17 of 18 cases. Ten cases had good to very good image quality. Two serious adverse events occurred; both were pancreatitis requiring hospitalization. LIMITATIONS: Limited sample size, small number of patients with confirmed pathological diagnosis, lack of coregistered pathology and images. CONCLUSIONS: nCLE in the pancreas is technically feasible via a 19-gauge needle under endosonographic guidance. Future studies will address identification of structures, diagnostic accuracy, and complication profiles. The rate of pancreatitis needs to be further clarified and mitigated.

21 Article An evaluation of risk factors for inadequate cytology in EUS-guided FNA of pancreatic tumors and lymph nodes. 2010

Cleveland, Patrick / Gill, Kanwar Rupinder S / Coe, Susan G / Woodward, Timothy A / Raimondo, Massimo / Jamil, Laith / Gross, Seth A / Heckman, Michael G / Crook, Julia E / Wallace, Michael B. ·Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Jacksonville, Florida, USA. ·Gastrointest Endosc · Pubmed #20598246.

ABSTRACT: BACKGROUND: The factors associated with maximizing the cytological adequacy of EUS-guided FNA (EUS-FNA) in pancreatic tumor evaluation are not well-known. OBJECTIVE: To examine associations of physician and procedural factors with the endpoint: the presence of an adequate cytological specimen found by using EUS-FNA in patients with pancreatic tumors and lymph nodes. DESIGN: Retrospective cohort study. SETTING: A U.S. tertiary care center. PATIENTS: Patients undergoing EUS-FNA of pancreatic masses and lymph nodes. INTERVENTIONS: Analysis of EUS-FNA procedures performed in our institution from 1997 to 2007. MAIN OUTCOME MEASUREMENTS: Associations were evaluated between the primary endpoint of cytological adequacy and factors including the endoscopist, needle gauge, the number of needle passes attempted, the pathologist, and the presence of an onsite cytotechnologist to confirm an adequate specimen. EUS-FNA adequacy was determined by a pathologist based on the presence of definite benign or malignant tissue. RESULTS: EUS-FNA was performed in 247 pancreatic masses and 276 lymph nodes. An adequate cytological sample was obtained in 240 (97%) pancreatic tumors (95% CI, 94%-99%) and 252 (91%) lymph nodes (95% CI, 87%-94%). For pancreatic tumors, there was no evidence of any associations between factors and cytological adequacy. For lymph nodes, cytological adequacy was improved when an onsite cytotechnologist was present (96% vs 84%, P = .002); no other factors showed statistically significant associations with cytological adequacy. LIMITATIONS: Retrospective study, low power to detect associations. CONCLUSIONS: The presence of an onsite cytotechnologist is an important factor in achieving successful EUS-FNA of suspicious lymph nodes in patients with pancreatic masses.

22 Article Pancreatic neuroendocrine tumors among patients with intraductal papillary mucinous neoplasms: real association or just a coincidence? 2009

Gill, Kanwar Rupinder S / Scimeca, Daniela / Stauffer, John / Krishna, Murli / Woodward, Timothy A / Jamil, Laith H / Wallace, Michael B / Nguyen, Justin H / Raimondo, Massimo. ·Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, USA. ·JOP · Pubmed #19734627.

ABSTRACT: CONTEXT: Intraductal papillary mucinous neoplasms (IPMNs) are being recognized with increased frequency and are the most common indication of pancreatic surgery at specialized centers. Many IPMN patients are found to have non-IPMN related pancreatic tumors like pancreatic neuroendocrine tumors (PNTs). OBJECTIVE: To study the prevalence of PNTs among patients with IPMN. METHODS: Patients who underwent surgical resection for IPMN were retrospectively reviewed for presence of histologically proven PNTs. The PNTs were evaluated for the patient demographics, imaging characteristics, histology, and surgical staging. RESULTS: Between January 2002 and October 2007, 104 patients underwent surgery for pancreatic IPMN. Among these, 4 patients (3.8%) were diagnosed with concomitant PNTs (1 male, 3 females; median age 72 years). Three patients had branch duct type-IPMN (cyst size: 19 mm, 15 mm and 27 mm), and one had main duct type-IPMN. Only one branch duct IPMN had adenocarcinoma, other three had low grade/borderline dysplasia. The median size of PNT was 10 mm (range 8-16 mm) and all were missed on the cross sectional imaging. Three patients were recognized by endoscopic ultrasound (EUS) and the fine needle aspiration confirmed the diagnosis in 1/3. Only one patient had metastatic PNT to lymph node, the other three were low grade lesions. CONCLUSION: IPMN and PNT can coexist. The prevalence of PNT among IPMN patients is low (3.8%). Our study is limited by small sample size. Large studies with large number of patients are needed to further explore this association.

23 Article CXC-chemokine/CXCR2 biological axis promotes angiogenesis in vitro and in vivo in pancreatic cancer. 2009

Matsuo, Yoichi / Raimondo, Massimo / Woodward, Timothy A / Wallace, Michael B / Gill, Kanwar R / Tong, Zhimin / Burdick, Marie D / Yang, Zhijian / Strieter, Robert M / Hoffman, Robert M / Guha, Sushovan. ·Department of Gastroenterology, Hepatology and Nutrition, The University of Texas M. D. Anderson Cancer Center, Houston, 77030, USA. ·Int J Cancer · Pubmed #19431209.

ABSTRACT: Angiogenesis is essential for tumor growth and metastasis. Although ELR(+)-CXC-chemokines and their corresponding receptor, CXC-receptor 2 (CXCR2), are known mediators of angiogenesis, little is known about their role in pancreatic cancer (PaCa). The aim of our study was to determine the role of ELR(+)-CXC-chemokine/CXCR2 biological axis in promoting PaCa angiogenesis. We prospectively collected secretin-stimulated exocrine pancreatic secretions (SSEPS) from normal individuals (NP) and PaCa patients. We showed that summed concentrations of ELR(+)-CXC-chemokines in SSEPS from PaCa patients were significantly higher than in those from NP (p = 0.002). We measured ELR(+)-CXC-chemokine levels in supernatants from multiple PaCa cell lines and confirmed that BxPC-3, Colo-357 and Panc-28 had significantly higher expression compared with an immortalized human pancreatic ductal epithelial (HPDE) cell line. After confirming lack of autocrine effects of ELR(+)-CXC-chemokines on PaCa cells (due to absence of CXCR2 expression), we investigated paracrine effects of these chemokines on human umbilical vein endothelial cells (HUVEC). Both recombinant ELR(+)-CXC-chemokines and co-culturing with BxPC-3 significantly enhanced proliferation, invasion, and tube formation of HUVEC (p < 0.05). These biological effects were significantly inhibited by treatment with a neutralizing antibody against CXCR2 (anti-CXCR2 Ab) (p < 0.05). Finally, anti-CXCR2 Ab significantly reduced tumor volume (p < 0.05), Ki-67 proliferation index (p = 0.043) and Factor VIII(+) microvessel density (p = 0.004) in an orthotopic nude mouse PaCa model. Our results show that ELR(+)-CXC-chemokines promote PaCa tumor-associated angiogenesis through CXCR2, suggesting that CXCR2 is an anti-angiogenic target in PaCa.

24 Article Branch duct intraductal papillary mucinous neoplasm of the pancreas in solid organ transplant recipients. 2009

Gill, Kanwar Rupinder S / Pelaez-Luna, Mario / Keaveny, Andrew / Woodward, Timothy A / Wallace, Micheal B / Chari, Suresh T / Smyrk, Thomas C / Takahashi, Naoki / Clain, Jonathan E / Levy, Michael J / Pearson, Randall K / Petersen, Bret T / Topazian, Mark D / Vege, Santhi S / Kendrick, Michael / Farnell, Michael B / Raimondo, Massimo. ·Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida 32224, USA. ·Am J Gastroenterol · Pubmed #19352341.

ABSTRACT: OBJECTIVES: In immunosuppressed patients with branch duct intraductal papillary mucinous neoplasm (IPMN-Br) associated with solid organ transplantation, the risk of major pancreatic surgery has to be weighed against the risk of progression to malignancy. Recent studies show that IPMN-Br without consensus indications for resection (CIR) can be followed conservatively. We analyzed the course of IPMN-Br in patients with and without solid organ transplant. METHODS: We compared clinical and imaging data at diagnosis and follow-up of 33 IPMN-Br patients with solid organ transplant (T-IPMN-Br) with those of 57 IPMN-Br patients who did not undergo transplantation (NT-IPMN-Br). In T-IPMN-Br, we noted pre- and post-transplant imaging and cyst characteristics. This case-control study was conducted in a tertiary-care hospital for patients with IPMN-Br. RESULTS: T-IPMN-Br patients were younger than the NT-IPMN-Br patients (63 vs. 68 years, P = 0.01). The median duration of follow-up for the groups was similar (29 vs. 28 months, P = NS). CIR were present in 24% (8/33) of T-IPMN-Br patients and 32% (18/57) of NT-IPMN-Br. New CIR were noted in 6% (2/33) of patients in the T-IPMN-Br group during a median follow-up of 17 months (range, 3-100 months) compared with 4% (2/57) of patients in the NT-IPMN-Br group (P = NS). Eleven patients (10 NT-IPMN-Br, 1 T-IPMN-Br) underwent surgery during follow-up. Only one NT-IPMN-Br patient was diagnosed with malignancy; all others had benign IPMN-Br. CONCLUSIONS: In participants with IPMN-Br, short-term follow-up after solid organ transplant was not associated with any significant change in cyst characteristics suggesting that incidental IPMN-Br, even in the setting of immunosuppression post-transplant, can be followed conservatively.

25 Article Quality in EUS: an assessment of baseline compliance and performance improvement by using the American Society for Gastrointestinal Endoscopy-American College of Gastroenterology quality indicators. 2009

Coe, Susan G / Raimondo, Massimo / Woodward, Timothy A / Gross, Seth A / Gill, Kanwar Rupinder S / Jamil, Laith H / Al-Haddad, Mohammad / Heckman, Michael G / Crook, Julia E / Diehl, Nancy N / Wallace, Michael B. ·Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida 32224, USA. ·Gastrointest Endosc · Pubmed #19185684.

ABSTRACT: BACKGROUND: An American Society for Gastrointestinal Endoscopy-American College of Gastroenterology (ASGE-ACG) task force recently developed quality indicators for the preprocedure, intraprocedure, and postprocedure phases of each endoscopic procedure. Benchmark rates and clinical significance of compliance have not been determined. OBJECTIVES: To establish baseline compliance rates to the preprocedure and intraprocedure quality indicators in our EUS cases, identify indicators with the lowest compliance rates, and establish change in compliance rates with a targeted performance improvement plan. METHODS: We measured baseline compliance to each of the preprocedure and intraprocedure EUS quality indicators in the EUS procedures performed at Mayo Clinic Jacksonville from March 1996 through August 2006. We developed a performance improvement plan that targeted the 4 indicators with the lowest compliance over the entire time period. Compliance rates in the year after plan implementation were compared with those from January 2004 to August 2006, when adjusting for endoscopist and direct access. RESULTS: We demonstrated areas of high quality as well as areas for improvement in compliance with the ASGE-ACG quality metrics in a large cohort of EUS cases. We achieved improvement in all 4 areas targeted for quality improvement, statistically significant at the 5% level for two of the quality indicators. LIMITATIONS: Limitations included our retrospective design and the use of unstructured procedure dictations that may limit application of our results. It is also unclear whether compliance was truly synonymous with performance. CONCLUSIONS: We established reference levels of compliance rate within our practice and showed that a targeted performance improvement plan that consisted of awareness, individual accountability, and documentation can result in improvement.

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