68 In a small study of 14 patients, EUS-guided ethanol lavage with paclitaxel injection resulted in complete resolution of cystic tumor in 11 patients and partial resolution in two.26 A further study by the same investigator showed that complete resolution was achieved in 29 of 47 patients (62%), with a median 22 months of follow up. The ablative effect of this local therapy was documented on the resected specimens.27 In summary, as long-term prospective data on pancreatic cysts are still not available in Asia, management
strategies are largely based on risk stratification by surgical selleck kinase inhibitor risk and malignant potential. Sato et al. reported that gene expression profiling revealed overexpression of claudin 4, chemokine receptor 4, S100A4, and mesothelin in patients with invasive IPMN.21 Larger prospective trials are needed to confirm these results. In an exploratory study, proteomic analysis of pancreatic cyst fluid in 20 patients was performed; two homologs of amylase, solubilized molecules of four mucins, four solubilized CEA-related cell adhesion molecules, and four S100 homologs might be candidate biomarkers to facilitate future pancreatic cyst diagnosis and risk stratification. This approach presents click here a novel method for evaluating pancreatic cysts, and offers the possibility of analyzing smaller pancreatic cysts, as only less than 40 mL cyst fluid per sample is required.69 In vivo real-time
imaging can be performed using confocal laser endomicroscopy. This technology allows the EUS-guided
placement of a miniprobe through a MCE公司 22G needle inside various lesions located in the vicinity of the digestive tract.70 There is currently an ongoing multicentre study involving several centres in Europe and the USA that aims to determine the utility of this device for the diagnosis of pancreatic cysts. Given that there are centres in Asia that have already published data on confocal laser endomicroscopy,31 it is possible that EUS-guided confocal laser endomicroscopy might feature in Asia soon. Published data on the prevalence, risk factors, diagnosis, management strategies, and long-term outcome of pancreatic cysts in Asia remain limited at present. We recommend establishing a regional registry of pancreatic cystic lesions to clarify these data. We would like to thank Dr Hyoung-Chul Oh (Chung-Ang University College of Medicine, YongSan Hospital, Seoul, Korea), Dr Atsushi Sofuni, Dr Fumihide Itokawa, Dr Toshio Kurihara, Dr Takayoshi Tsuchiya, Dr Shujiro Tsuji, Dr Kentaro Ishii, Dr Nobuhito Ikeuchi, Dr Junko Umeda, Dr Reina Tanaka, and Dr Fuminori Moriyasu (Tokyo Medical University) for their important contributions. “
“Nonalcoholic steatohepatitis (NASH) is the commonest liver disease in developed countries. However, there are no current data on the cost-effectiveness of therapeutic options such as lifestyle modification, pioglitazone, or vitamin E.