mesenteric mass

good morning. we are back at juã¡rez... for another... case with echoendoscopy (endoscopic ultrasound [eus]) this is a very interesting story. we have here a patient... 27 years old... who has experienced recurring pancreatitis... since she was 6 years old. we are speaking of 20 years with the disease.

this poor patient had a... severely dilated pancreatic duct... with calcified stones. she had an ercp performed... that drained the... pancreatic duct with a plastic stent. the problem is that during the procedure... we realized that the tail... looked abnormal. there was a lesion...

it isn't clear whether inflammatory... or cancerous, or pseudo-tumoral. so the best way to... understand what is going on with the tail... and determine the best therapeutic option... is to perform an eus with fine-needle aspiration (fna). my associate, dr. reem sharaiha... is now beginning the eus. she is approaching the aorta...

trying to find the celiac trunk. we can see it there. it's the basis of all eus.... aimed at the pancreas... to begin with the celiac trunk. we can see an abnormal.. pancreas, with calcified stones. there are many calcified stones... that slightly complicate the procedure...

because... examining the pancreas... in the presence of so many stones... there are many artifacts. we can see here the pancreatic duct... between the calcified stones. dr. reem just showed the confluence... between the splenic and portal veins. the pancreatic duct...

is the place (on the screen) where... the color (doppler) is not... in motion, so... there is no blood flow. many stones here.. in the duct and the pancreas parenchyma. the pancreatic duct is 3 mm... in the section of the body. she is trying to find the junction...

between the body and the tail of the pancreas. we just observed the... tail of the pancreas... located between the kidneys. we can see the portal vein there... near the junction with the splenic vein. many stones. trying to look for a lesion... that may explain...

the... the images in the scanner. she is trying to improve the depth... of the system. we are using an olympus system... with the endoscope... gf-uct180. we can observer significant characterization of... chronic pancreatitis...

calcification... there is scarring... there are places where the branches are dilated... all these criteria... are characteristics of chronic pancreatitis. dr. reem will now move toward... the head of the pancreas to finish the exam. she is now in the bulb. the bile duct...

is now crossing... through the head of the pancreas. this is the bile duct. 4.0 mm not dilated. we will move forward to see.. to see how it's passing through... the head of the pancreas and reaching the hilum... in the liver.

we can also note... the presence of stones in the head of the pancreas. it is difficult to find the pancreatic duct... with the many calcific stones in the head. the duct isn't as dilated as in other sections in the pancreas. johnny has a very interesting question... if the pancreatic stent can result in an artifact... it can... but not as much as with metallic stents.

metallic stents result in more artifacts. yes, there is a plastic stent. exactly. it was placed by johnny to drain the pancreatic duct. no, it was no secret. felipe has an interesting question. he's asking whether we have to... biopsy the pancreas in this case. there is a pseudo-cyst.

there is plenty of characterization... of inflammation related to chronic disease. related to her disease. but there is no particular area... that looks especially suspicious. so dr. reem is... mentioning something very important... a patient this young... with recurring, chronic pancreatitis without...

without history of alcoholism... it is important to monitor for... genetic disease. look for a genetic mutation... of any kind. maybe to allow for a more efficient... drainage of the pancreatic duct... we will have to perform... extracorporeal lithotripsy.

that is performed in collaboration with... the urology service. urologists... make extensive use of extracorporeal lithotripsy. and maybe after... fragmenting the stones... we will be able to place... larger plastic stents... to recalibrate the pancreatic duct.

we well re-check the tail... to see if... there any need for biopsy. perfect. johnny is asking... whether use of spyglass is indicated in this case. it would be advised... especially in this case... to perform intraductal lithotripsy.

for example... using laser. that would be a possibility. but... dr. reem just demonstrated that the patient... only has... characteristics of chronic pancreatitis... with chronic inflammation... there is nothing suggestive of cancer... now it is important to treat the symptoms of the patient.

thank you, dr. reem. voila!