IECED: Outreach Center of the World Endoscopy Organization
On October 5, 2011 the Ecuadorian Institute of Digestive Diseases of Guayaquil has been recognized as a Center of the World Endoscopy Organization (WEO)
Dr James Di Sario, Chair of the World Endoscopy Organization (WEO) during the presentation of the Pentax Training Center
Inauguration of the Pentax Training Center
On October 5, 2011 in association with the World Endoscopy Organization (WEO) and the company PENTAX Japan was the inauguration of the first Latin America Training Center in the Ecuadorian Institute of Digestive Diseases, in the OMNI Hospital located in Guayaquil city.
During the inauguration: Carlos Robles-Medranda, MD (Director of the Center); James Di Sario, MD (World Endoscopy Organization) and David Woods (Pentax America)
David Woods (President of Pentax America), Igor Nemacelff (Pentax Latin America), Carlos Robles-Medranda (IECED, Director of the Pentax Training Center), Peter Mendiola (Pentax Latin America), James Di Sario (World Endoscopy Organization), Ramon Barredo (OMNI Hospital- Medical Director)
Pancreatic Cyst
Pancreatic Cyst: Diagnostic Approach
A 63-year old woman was admitted because of a non symptomatic pancreatic cyst of 7.0 x 8.0 cm diagnosed by an abdominal ultrasound. She had a past history of breast cancer treated by surgery, radiotherapy and chemotherapy one year before. Physical examination was normal. Blood tests including tumor markers as carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (Ca 19-9) and the carbohydrate antigen 15-3 (Ca 15-3) were normal.
After a CT-scan, an Endoscopy Ultrasound with a fine needle aspiration (FNA-EUS) was indicated as a diagnostic approach. EUS-FNA was performed under anesthesia, with antibiotic prophylaxis, using an ultrasound needle EZ-Shot (NA-200H-8022B, Olympus)
The liquid analysis showed tumor markers elevated as follows:
CEA 359,8 ng/ml (N= 0 - 4,60),
Ca19-9 474,9 U/ml (N= 0 - 37),
Ca72-4 580,1 U/ml (N= 0 - 7).
Amylase 176 U/l (N= <120),
Lipase 150 (N= <120),
LDH 333 (N= <200)
The final diagnostic of Mucinous Cyst Adenoma was done.
Discussion:
Pancreatic cysts are found in 25% of patients that are evaluated during radiologic examinations. Diferential diagnosis includes basically pseudocysts, serous adenomas, mucinous adenomas and cystoadenocarcinomas. Although very rare, in our patient the possibility of a pancreatic pseudocyst secondary to asymptomatic pancreatitis post chemotherapy existed.
At endoscopy ultrasound (EUS) the pancreatic cystic lesions have certain morphologic characteristics that help to clarify their origin (mucinous or not). Mucinous lesions are bigger in size and usually present a septum or wall inside of the cyst. However, sometimes these characteristics are not enough and EUS-FNA with cystic liquid analyses becomes necessary.
Liquid analysis with a Ca 72-4 level >40 U/ml has a 63% sensitivity and 98% specificity for distinguishing mucinous cystadenomas and cystadenocarcinomas from serous cystadenomas and pseudocysts. A CEA level >400 ng/ml has a 57% sensitivity and a 100% specificity for distinguishing mucinous tumours and cystadenocarcinomas from pseudocysts. A CEA level <4 ng/ml had a 100% sensitivity and a 93% specificity for distinguishing serous cystadenomas from mucinous cystadenomas, cystadenocarcinomas and pseudocysts.
Finally, FNA-EUS with a combined measurement of CA 72-4 and CEA may be used to distinguish accurately mucinous cystadenomas and cystadenocarcinomas from serous cystadenomas and pseudocysts.
References:
1. Hammel P, et al. Diagnostic value of CA 72-4 and carcinoembryonic antigen determination in the fluid of pancreatic cystic lesions. Eur J Gastroenterol Hepatol. 1998 Apr; 10 (4):345-8.
2. Hammel P, et al. Preoperative cyst fluid analysis is useful for the differential diagnosis of cystic lesions of the pancreas. Gastroenterology. 1995 Apr; 108 (4):1230-5.
Special report: Endoscopy and its development
IECED in the OMNI Hospital
After a strategic alliance with the OMNI Hospital, we communicate to our patients that the IECED Center has been moved to this hospital.
We are located in the Vitalis Tower, OMNI Hospital, Mezanine 1, Av. Abel R Castillo and Av. Juan Tanca Marengo, Ciudad del Sol (City of Sun)
Presentation of New Technologies
The news published on 24/08/2009 in “El Diario Manabita” journal.
Editorial
In this space you will find information about different medical conditions and their treatment with the clearest and most up-to-date information — that may be helpful for patients, colleagues, medical students and visitors.
Additionally, you will find information about our medical and technical staff and about some of the activities and events that have characterized our institution over the years.
Carlos Robles-Jara, M.D.
IECED - Director.