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Pankreatik psödokistlerde tanısal yöntemlerin performansı

Yıl 2022, Cilt: 21 Sayı: 3, 136 - 148, 29.12.2022
https://doi.org/10.17941/agd.1222894

Öz

Giriş ve Amaç: Pankreas kistik lezyonlarının tedavisini yönetmek çoğu zaman klinisyen için zordur. Bu nedenle ayırıcı tanı yapılması için öykü, klinik, laboratuvar, radyolojik görüntüleme, endoskopik ultrasonografi, endoskopik ultrasonografi - ince iğne aspirasyon biyopsisi ile alınan kist sıvı analizi ve sitopatoloji verilerinin değerlendirilmesi önemlidir. Endoskopik ultrasonografi ile saptanan pankreatik psödokistlerin yönetiminde görüntüleme yöntemlerinin performansını ve endoskopik ultrasonografi eşliğinde endoskopik drenaj işlemi yaptığımız hastaların klinik özelliklerini çalışmamızda inceledik. Gereç ve Yöntem: Çalışmamızda Temmuz 2009-Ocak 2018 tarihleri arasında Dokuz Eylül Üniversitesi Tıp Fakültesi Hastanesi İç Hastalıkları Anabilim Dalı Gastroenteroloji Kliniği Endoskopi Ünitesinde pankreas kisti nedeniyle endoskopik ultrasonografi yapılan 18 yaş üstü hastalar retrospektif olarak değerlendirilmiştir. Endoskopik ultrasonografi ve/veya endoskopik ultrasonografi - ince iğne aspirasyon biyopsisi değerlendirilmesi sonucu Atlanta klasifikasyonuna göre pankreatik psödokist tanısı alan 102 hasta çalışmaya dahil edilmiştir. Hastaların demografik verileri, klinik özellikleri, laboratuvar verileri, radyolojik/endoskopik ultrasonografi görüntü raporları ve patolojik inceleme sonuçları retrospektif olarak değerlendirilmiştir. Bulgular: Radyolojik açıdan pankreas kistlerini, psödokist olarak ayırma yüzdesi bilgisayarlı tomografi için %58.3, magnetik rezonans için %70.5, endoskopik ultrasonografi için %84.3, endoskopik ultrasonografi + ince iğne aspirasyon biyopsisi için ise %100 olarak saptanmıştır. Tanısal performans olarak bilgisayarlı tomografi %47.5, magnetik rezonans %63.1, endoskopik ultrasonografi %78.4, endoskopik ultrasonografi + ince iğne aspirasyon biyopsisi %95 olarak saptanmıştır. Pankreatik psödokist tanılı 102 hastadan, 36’sına drenaj işlemi uygulanmıştır. Drenaj işlemi uygulanan 36 hastanın, 35’inde tam rezolüsyon, 1 hastada kısmi rezolüsyon sağlanmıştır. Drenaj işlemi uygulanan ve uygulanmayan hastalar arasında yaş, cinsiyet, kistin lokalizasyonu, serum C reaktif protein, serum amilaz, kist amilaz, kist karsinoembriyonik antijeni, kist karbonhidrat antijen 19-9 düzeyleri kıyaslandığında anlamlı farklılık elde edilememiştir. Sonuç: Pankreatik psödokistlerin tanısında ve izleminde bilgisayarlı tomografi ve magnetik rezonansa kıyasla endoskopik ultrasonografi ve endoskopik ultrasonografi - ince iğne aspirasyon biyopsisi daha yüksek tanısal duyarlılığa sahiptir. Buna rağmen %15’e varan oranda endoskopik ultrasonografi ve endoskopik ultrasonografi - ince iğne aspirasyon biyopsisi neoplastik/benign kist ayrımını yapmada yeterli olamamaktadır. Günümüzde pankreatik psödokistlerde endoskopik drenaj zamanlaması ile ilgili bir fikir birliği bulunmamaktadır. Bizim uyguladığımız endoskopik ultrasonografi eşliğinde drenaj işlemlerindeki yüksek başarı ve düşük komplikasyon oranları bize hastaların büyük bir kısmı için bu yöntemin uygun olduğunu ve kabul edilebilir oranda risk taşıdığını göstermektedir

Kaynakça

  • 1. Barthet M , Bugallo M, Moreira LS, Bastid C, Sastre B, Sahel J. Treatment of pseudocysts in acute pancreatitis. Retrospective study of 45 patients. Gastroenterologie clinique et biologique, 1992:16(11):853-859.
  • 2. Beckingham IJ , Krige JE , Bornman PC, Terblanche J. Endoscopic management of pancreatic pseudocysts. Br J Surg, 1997:84(12):1638-1645.
  • 3. Lee HJ, Kim MJ, Choi JY, Hong HS, Kim KA. Relative accuracy of CT and MRI in the differentation of benign from malignant pancretic cystic lesions. Clinical Radiology, 2011:66(4):315-321.
  • 4. Cannon JW , Callery MP, Vollmer CM. Diagnosis and Manegement of Pancreatic Pseudocysts: What is the evidence? J Am Coll Surg. 2009:209(3):385-393.
  • 5. Elta GH , Enestvedt BK , Sauer BG , Lennon AM. ACG Clinical Guideline: Diagnosis and Manegement of Pancreatic cysts. Am J Gastroenterol. 2007:102(10):464-479.
  • 6. O'Toole D , Palazzo L, Hammel P, Yaghlene LB, Couvelard A, Felce-Dachez M, et al. Macrocystic pancreatic cystadenoma: The role of EUS and cyst fluid analysis in distinguishing mucinous and serous lesions. GastrointestEndosc, 2004:59(7):823-829.
  • 7. Samarasena JB , Nakai Y, Chang KJ. Endoscopic ultrasonography-guided fine-needle aspiration of pancreatic cystic lesions: a practical approach to diagnosis and management. Gastrointest Endosc Clin N Am, 2012: 22(2):169-185.
  • 8. Okasha H, Behiry ME, Ramadan N, Ezzat R, Yamany A, El-Kholi S, et al. Endoscopic ultrasound-guided fine needle aspiration in diagnosis of cystic pancreatic lesions. Arab J Gastroenterol. 2019:20(2):86-90.
  • 9. Şenol K, Akgül Ö, Gündoğdu SB , Aydoğan İ , Tez M , Coşkun F, Tihan DN. Can outcome of pancreatic pseudocysts be predicted? Proposal for a new scoring system.Ulus Travma Acil Cerrahi Derg. 2016:22(2):150-154
  • 10. Yamada S, Fujii T, Murotani K , Kanda M, Sugimoto H , Nakayama G, et al. Comparison of the international consensus guidelines for predicting malignancy in intraductal papillary mucinous neoplasms. Surgery, 2016:159(3):58-64.
  • 11. Vilas-Boas F , Macedo G ; Pancreatic Cystic Lesions: New Endoscopic Trends in Diagnosis. J Clin Gastroenterol, 2018:52(1):13-19.
  • 12. Bradley EL. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on acute Pancreatitis, Atlanta,GA, September 11 through 13. Arch Surg 1993:128:586-590.
  • 13. Ge PS , Weizmann M , Watson RR. Pancreatic pseudocysts: advances in endoscopic management. Gastroenterology Clinics, 2016:45(1):9-27.
  • 14. Habashi S , Draganov PV. Pancreatic pseudocyst. World J Gastroenterol 2009:15(1).
  • 15. Yoon WJ , Brugge WR. Pancreatic cystic neoplasms: diagnosis and management. Gastroenterol Clin North Am, 2012:41(1):103-118.
  • 16. Curry CA , Eng J, Horton KM, Urban B, Siegelman S, Kuszyk BS, Fishman EK. CT of primary cystic pancreatic neoplasms: can CT be used for patient triage and treatment? American Journal of Roentgenology, 2000:175(1):99-103.
  • 17. Castillo CF , Targarona J, Thayer SP, Rattner DW, Brugge WR, Warshaw AL. Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Archives of Surgery, 2003:138(4):427-430.
  • 18. Attasaranya S , Pais S, LeBlanc J, McHenry L, Sherman S, DeWitt JM. Endoscopic ultrasound-guided fine needle aspiration and cyst fluid analysis for pancreatic cysts. Jop, 2007:8(5):553-563.
  • 19. Ng PY, Rasmussen DN, Vilmann P, Hassan H, Gheorman V, Burtea D, et al. Endoscopic Ultrasound-guided Drainage of Pancreatic Pseudocysts: Medium-Term Assessment of Outcomes and Complications. Endosc Ultrasound, 2013:2(4):199-203.
  • 20. Cho CS, Russ AJ, Loeffler AG, Rettammel RJ, Oudheusden G, Winslow ER, et al. Preoperative classification of pancreatic cystic neoplasms: the clinical significance of diagnostic inaccuracy. Ann Surg Oncol, 2013:20(9):3112-3119.
  • 21. Pitchumoni CS , Agarwal N. Pancreatic pseudocysts. When and how should drainage be performed? Gastroenterol Clin North Am 1999:28(3):615-639
  • 22. Siegelman SS, Copeland BE, Saba GP, Cameron JL, Sanders RC, Zerhouni EA. CT of fluid collections associated with pancreatitis. AJR Am J Roentgenol 1980:134 (6):1121-1132.
  • 23. Morgan DE , Baron TH, Smith JK, Robbin ML, Kenney PJ. Pancreatic fluid collections prior to intervention: evaluation with MR imaging compared with CT and US. Radiology 1997:203:773-778
  • 24. Koito K, Namieno T, Nagakawa T, Shyonai T, Hirokawa N, Morita K. Solitary cystic tumor of the pancreas: EUS-pathologic correlation. Gastrointestinal endoscopy, 1997:45(3):268-276.
  • 25. Hammel P, Levy P, Voitot H, Levy M,bVilgrain V, Zins M, Flejou JF, Molas G, Ruszniewski P, Bernades P. Preoperative cyst fluid analysis is useful for the differential diagnosis of cystic lesions of the pancreas. Gastroenterology 1995:108:1230-1235.
  • 26. Waaij LA, Dullemen HM, Porte RJ. Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis. Gastrointest Endosc 2005:62:383-389.
  • 27. Song TJ, Lee SS. Endoscopic drainage of pseudocysts. Clin Endosc, 2014:47(3):222-226.
  • 28. Lennon AM, Wolfgang C. Cystic neoplasms of the pancreas. J GastrointestSurg, 2013. 17(4). Percutaneous catheter drainage compared with internal drainage in the management of pancreatic pseudocyst. AnnSurg, 1992:215(6):571-578.
  • 29. Adams DB, Anderson MC. Percutaneous catheter drainage compared with internal drainage in the management of pancreatic pseudocyst. AnnSurg, 1992:215(6):571-578.
  • 30. Brugge WR, Lewandrowski K, Lewandrowski EL, Centeno BA, Szydlo T, Regan S, at al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 2004:126:1330-1336.
  • 31. Thosani N, Thosani S, Qiao W, Fleming JB, Bhutani MS, Guha S. Role of EUS-FNA-based cytology in the diagnosis of mucinous pancreatic cystic lesions: a systematic review and meta-analysis. Digestive diseases and sciences, 2010:55(10):2756-2766.
  • 32. Jong K , Nio CY, Mearadji B, Phoa SS, Engelbrecht MR, Dijkgraaf MG, at al. Disappointing interobserver agreement among radiologists for a classifying diagnosis of pancreatic cysts using magnetic resonance imaging. Pancreas, 2012:41(2):278-282.
  • 33. Oh HC, Brugge WR. EUS-guided pancreatic cystablation: a critical review (with video). Gastrointest Endosc, 2013:77(4):526-533.
  • 34. Lee HJ , Kim MJ, Choi JY, Hong HS, Kim KA. Relative accuracy of CT and MRI in the differentiation of benign from malignant pancreatic cystic lesions. Clinical radiology, 2011:66(4):315-321.
  • 35. Fisher WE, Hodges SE, Yagnik V, Morón FE, Wu MF, Hilsenbeck SG, et al. Accuracy of CT in predicting malignant potential of cystic pancreatic neoplasms. Hpb, 2008:10(6):483-490.
  • 36. Permert J, Ihse I, Jorfeldt L, Schenck HV, Arnqvist HJ, Larsson J. Pancreatic cancer is associated with impaired glucose metabolism. The European journal of surgery. Acta chirurgica, 1993:159(2):101-107.
  • 37. Canto MI , Hruban RH, Fishman EK, Kamel IR, Schulick R, Zhang Z, et al. Frequent detection of pancreatic lesions in asymptomatic high-risk individuals. Gastroenterology, 2012:142(4):796-804.
  • 38. Langer P, Kann PH, Fendrich V, Habbe N, Schneider M, Sina M, et al. Five years of prospective screening of high-risk individuals from families with familial pancreatic cancer. Gut, 2009:58(10):1410-1418.
  • 39. Kadiyala V, Lee LS. Endosonography in the diagnosis and management of pancreatic cysts. World J Gastrointest Endosc, 2015:7(3):213-223.
  • 40. Farrell JJ. Pancreatic cysts and guidelines. Digestive diseases and sciences, 2017:62(7):1827-1839
  • 41. Samuelson AL, Shah RJ. Endoscopic management of pancreatic pseudocysts. Gastroenterol Clin North Am 2012 (1):47-62.
  • 42. Holt BA, Varadarajulu S. The endoscopic management of pancreatic pseudocysts (with videos). Gastrointest Endosc, 2015:81(4):804-812.
  • 43. Giovannini M. Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections. Gastrointest Endosc Clin N Am, 2018:28(2):157-169.

Performance of diagnostic methods in pancreatic pseudocyst

Yıl 2022, Cilt: 21 Sayı: 3, 136 - 148, 29.12.2022
https://doi.org/10.17941/agd.1222894

Öz

Background and Aims: Managing the treatment of pancreatic cystic lesions is often difficult for the clinician. Therefore, history, clinical, laboratory, radiological imaging, endoscopic ultrasound, cyst fluid analysis obtained by endoscopic ultrasound guided fine needle aspiration biopsy and cytopathology data are important for differential diagnosis. In our study, we examined the performance of imaging methods in the management of pancreatic pseudocysts detected by endoscopic ultrasound and the clinical characteristics of patients who underwent endoscopic drainage by endoscopic ultrasound. Materials and Method: In our study, patients over 18 years of age who underwent endoscopic ultrasound for pancreatic cysts in the Endoscopy Unit of Dokuz Eylül University Faculty of Medicine, Department of Internal Medicine/Gastroenterology Clinic between July 2009 and January 2018 were evaluated retrospectively. 102 patients with pre-diagnosis of pancreatic pseudocyst according to Atlanta Classification as a result of endoscopic ultrasound and/or endoscopic ultrasound guided fine needle aspiration biopsy evaluation, and 36 patients who underwent cystogastrostomy/cystoduodenostomy were included in the study. Demographic data, clinical characteristics, laboratory data, radiological/endoscopic ultrasound image reports and pathological examination results of the patients were evaluated retrospectively. Results: Radiologically, the percentage of separating pancreatic cysts as pseudocyst was 58.3% for computed tomography, 70.5% for magnetic resonance imaging, 84.3% for endoscopic ultrasound, and 100% for endoscopic ultrasound guided fine needle aspiration biopsy. Diagnostic performance was found to be 47.5% in computed tomography, 63.1% in magnetic resonance imaging, 78.4% in endoscopic ultrasound, and 95% in endoscopic ultrasound guided fine needle aspiration biopsy. Drainage procedure was applied to 36 of 102 patients with pancreatic pseudocyst. Complete resolution was achieved in 35 of 36 patients who underwent drainage procedure, and partial resolution was achieved in 1 patient. When the age, gender, localization of the cyst, serum C-reactive protein, serum amylase, cyst amylase, cyst carcinoembryonic antigen, cyst arbohydrate antigen 19-9 levels were compared, no significant difference was found between patients who underwent and did not undergo drainage. Conclusion: Compared to computed tomography and magnetic resonance imaging, endoscopic ultrasound and endoscopic ultrasound guided fine needle aspiration biopsy have higher diagnostic sensitivity in the diagnosis and follow-up of pancreatic pseudocysts. Despite this, up to 15% of endoscopic ultrasound and endoscopic ultrasound guided fine needle aspiration biopsy are not sufficient to differentiate between neoplastic/benign cysts. Today, there is no consensus on the timing of endoscopic drainage in pancreatic pseudocyst. The high success and low complication rates in our endoscopic ultrasound - guided drainage procedures show us that this method is suitable for most of the patients and carries an acceptable risk.

Kaynakça

  • 1. Barthet M , Bugallo M, Moreira LS, Bastid C, Sastre B, Sahel J. Treatment of pseudocysts in acute pancreatitis. Retrospective study of 45 patients. Gastroenterologie clinique et biologique, 1992:16(11):853-859.
  • 2. Beckingham IJ , Krige JE , Bornman PC, Terblanche J. Endoscopic management of pancreatic pseudocysts. Br J Surg, 1997:84(12):1638-1645.
  • 3. Lee HJ, Kim MJ, Choi JY, Hong HS, Kim KA. Relative accuracy of CT and MRI in the differentation of benign from malignant pancretic cystic lesions. Clinical Radiology, 2011:66(4):315-321.
  • 4. Cannon JW , Callery MP, Vollmer CM. Diagnosis and Manegement of Pancreatic Pseudocysts: What is the evidence? J Am Coll Surg. 2009:209(3):385-393.
  • 5. Elta GH , Enestvedt BK , Sauer BG , Lennon AM. ACG Clinical Guideline: Diagnosis and Manegement of Pancreatic cysts. Am J Gastroenterol. 2007:102(10):464-479.
  • 6. O'Toole D , Palazzo L, Hammel P, Yaghlene LB, Couvelard A, Felce-Dachez M, et al. Macrocystic pancreatic cystadenoma: The role of EUS and cyst fluid analysis in distinguishing mucinous and serous lesions. GastrointestEndosc, 2004:59(7):823-829.
  • 7. Samarasena JB , Nakai Y, Chang KJ. Endoscopic ultrasonography-guided fine-needle aspiration of pancreatic cystic lesions: a practical approach to diagnosis and management. Gastrointest Endosc Clin N Am, 2012: 22(2):169-185.
  • 8. Okasha H, Behiry ME, Ramadan N, Ezzat R, Yamany A, El-Kholi S, et al. Endoscopic ultrasound-guided fine needle aspiration in diagnosis of cystic pancreatic lesions. Arab J Gastroenterol. 2019:20(2):86-90.
  • 9. Şenol K, Akgül Ö, Gündoğdu SB , Aydoğan İ , Tez M , Coşkun F, Tihan DN. Can outcome of pancreatic pseudocysts be predicted? Proposal for a new scoring system.Ulus Travma Acil Cerrahi Derg. 2016:22(2):150-154
  • 10. Yamada S, Fujii T, Murotani K , Kanda M, Sugimoto H , Nakayama G, et al. Comparison of the international consensus guidelines for predicting malignancy in intraductal papillary mucinous neoplasms. Surgery, 2016:159(3):58-64.
  • 11. Vilas-Boas F , Macedo G ; Pancreatic Cystic Lesions: New Endoscopic Trends in Diagnosis. J Clin Gastroenterol, 2018:52(1):13-19.
  • 12. Bradley EL. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on acute Pancreatitis, Atlanta,GA, September 11 through 13. Arch Surg 1993:128:586-590.
  • 13. Ge PS , Weizmann M , Watson RR. Pancreatic pseudocysts: advances in endoscopic management. Gastroenterology Clinics, 2016:45(1):9-27.
  • 14. Habashi S , Draganov PV. Pancreatic pseudocyst. World J Gastroenterol 2009:15(1).
  • 15. Yoon WJ , Brugge WR. Pancreatic cystic neoplasms: diagnosis and management. Gastroenterol Clin North Am, 2012:41(1):103-118.
  • 16. Curry CA , Eng J, Horton KM, Urban B, Siegelman S, Kuszyk BS, Fishman EK. CT of primary cystic pancreatic neoplasms: can CT be used for patient triage and treatment? American Journal of Roentgenology, 2000:175(1):99-103.
  • 17. Castillo CF , Targarona J, Thayer SP, Rattner DW, Brugge WR, Warshaw AL. Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Archives of Surgery, 2003:138(4):427-430.
  • 18. Attasaranya S , Pais S, LeBlanc J, McHenry L, Sherman S, DeWitt JM. Endoscopic ultrasound-guided fine needle aspiration and cyst fluid analysis for pancreatic cysts. Jop, 2007:8(5):553-563.
  • 19. Ng PY, Rasmussen DN, Vilmann P, Hassan H, Gheorman V, Burtea D, et al. Endoscopic Ultrasound-guided Drainage of Pancreatic Pseudocysts: Medium-Term Assessment of Outcomes and Complications. Endosc Ultrasound, 2013:2(4):199-203.
  • 20. Cho CS, Russ AJ, Loeffler AG, Rettammel RJ, Oudheusden G, Winslow ER, et al. Preoperative classification of pancreatic cystic neoplasms: the clinical significance of diagnostic inaccuracy. Ann Surg Oncol, 2013:20(9):3112-3119.
  • 21. Pitchumoni CS , Agarwal N. Pancreatic pseudocysts. When and how should drainage be performed? Gastroenterol Clin North Am 1999:28(3):615-639
  • 22. Siegelman SS, Copeland BE, Saba GP, Cameron JL, Sanders RC, Zerhouni EA. CT of fluid collections associated with pancreatitis. AJR Am J Roentgenol 1980:134 (6):1121-1132.
  • 23. Morgan DE , Baron TH, Smith JK, Robbin ML, Kenney PJ. Pancreatic fluid collections prior to intervention: evaluation with MR imaging compared with CT and US. Radiology 1997:203:773-778
  • 24. Koito K, Namieno T, Nagakawa T, Shyonai T, Hirokawa N, Morita K. Solitary cystic tumor of the pancreas: EUS-pathologic correlation. Gastrointestinal endoscopy, 1997:45(3):268-276.
  • 25. Hammel P, Levy P, Voitot H, Levy M,bVilgrain V, Zins M, Flejou JF, Molas G, Ruszniewski P, Bernades P. Preoperative cyst fluid analysis is useful for the differential diagnosis of cystic lesions of the pancreas. Gastroenterology 1995:108:1230-1235.
  • 26. Waaij LA, Dullemen HM, Porte RJ. Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis. Gastrointest Endosc 2005:62:383-389.
  • 27. Song TJ, Lee SS. Endoscopic drainage of pseudocysts. Clin Endosc, 2014:47(3):222-226.
  • 28. Lennon AM, Wolfgang C. Cystic neoplasms of the pancreas. J GastrointestSurg, 2013. 17(4). Percutaneous catheter drainage compared with internal drainage in the management of pancreatic pseudocyst. AnnSurg, 1992:215(6):571-578.
  • 29. Adams DB, Anderson MC. Percutaneous catheter drainage compared with internal drainage in the management of pancreatic pseudocyst. AnnSurg, 1992:215(6):571-578.
  • 30. Brugge WR, Lewandrowski K, Lewandrowski EL, Centeno BA, Szydlo T, Regan S, at al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 2004:126:1330-1336.
  • 31. Thosani N, Thosani S, Qiao W, Fleming JB, Bhutani MS, Guha S. Role of EUS-FNA-based cytology in the diagnosis of mucinous pancreatic cystic lesions: a systematic review and meta-analysis. Digestive diseases and sciences, 2010:55(10):2756-2766.
  • 32. Jong K , Nio CY, Mearadji B, Phoa SS, Engelbrecht MR, Dijkgraaf MG, at al. Disappointing interobserver agreement among radiologists for a classifying diagnosis of pancreatic cysts using magnetic resonance imaging. Pancreas, 2012:41(2):278-282.
  • 33. Oh HC, Brugge WR. EUS-guided pancreatic cystablation: a critical review (with video). Gastrointest Endosc, 2013:77(4):526-533.
  • 34. Lee HJ , Kim MJ, Choi JY, Hong HS, Kim KA. Relative accuracy of CT and MRI in the differentiation of benign from malignant pancreatic cystic lesions. Clinical radiology, 2011:66(4):315-321.
  • 35. Fisher WE, Hodges SE, Yagnik V, Morón FE, Wu MF, Hilsenbeck SG, et al. Accuracy of CT in predicting malignant potential of cystic pancreatic neoplasms. Hpb, 2008:10(6):483-490.
  • 36. Permert J, Ihse I, Jorfeldt L, Schenck HV, Arnqvist HJ, Larsson J. Pancreatic cancer is associated with impaired glucose metabolism. The European journal of surgery. Acta chirurgica, 1993:159(2):101-107.
  • 37. Canto MI , Hruban RH, Fishman EK, Kamel IR, Schulick R, Zhang Z, et al. Frequent detection of pancreatic lesions in asymptomatic high-risk individuals. Gastroenterology, 2012:142(4):796-804.
  • 38. Langer P, Kann PH, Fendrich V, Habbe N, Schneider M, Sina M, et al. Five years of prospective screening of high-risk individuals from families with familial pancreatic cancer. Gut, 2009:58(10):1410-1418.
  • 39. Kadiyala V, Lee LS. Endosonography in the diagnosis and management of pancreatic cysts. World J Gastrointest Endosc, 2015:7(3):213-223.
  • 40. Farrell JJ. Pancreatic cysts and guidelines. Digestive diseases and sciences, 2017:62(7):1827-1839
  • 41. Samuelson AL, Shah RJ. Endoscopic management of pancreatic pseudocysts. Gastroenterol Clin North Am 2012 (1):47-62.
  • 42. Holt BA, Varadarajulu S. The endoscopic management of pancreatic pseudocysts (with videos). Gastrointest Endosc, 2015:81(4):804-812.
  • 43. Giovannini M. Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections. Gastrointest Endosc Clin N Am, 2018:28(2):157-169.
Toplam 43 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler
Yazarlar

Yavuz Özden Bu kişi benim

Göksel Bengi

Funda Barlık Obuz Bu kişi benim

Canan Altay

Özgül Sağol

Anıl Aysal Ağalar

Tarkan Ünek Bu kişi benim

Müjde Soytürk Bu kişi benim

Yayımlanma Tarihi 29 Aralık 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 21 Sayı: 3

Kaynak Göster

APA Özden, Y., Bengi, G., Barlık Obuz, F., Altay, C., vd. (2022). Pankreatik psödokistlerde tanısal yöntemlerin performansı. Akademik Gastroenteroloji Dergisi, 21(3), 136-148. https://doi.org/10.17941/agd.1222894

test-5