Background: Though endoscopic ultrasound is used more frequently for evaluation of upper gastrointestinal (GI) tract lesions, but it has many utilities for lower GI diseases. The aim of this study was to report the results of endo-anal sonography in 108 patients who underwent the procedure.Methods: 108 patients, who underwent endoscopic ultrasound of the lower GI tract, were retrospectively studied. Patients were divided into three groups. Group 1: patients with gas or fecal incontinence, group 2: patients with rectal cancer, and group thee: patients with suspected perianal fistulas and abscesses. Results: A total of 108 patients (45 men) with a mean age of 37.9 were enrolled. Group 1 comprised of 68 patients (17 men, 51 women). External or internal anal sphincter lesion was diagnosed in 61 of them. Group 2 consisted of 24 patients (16 men, 8 women). Stage 1 (T1 NO) of rectal tumor was diagnosed in 3 patients. Their tumor was treated with local excision. T1 stage was confirmed in 2 of them. Group 3 comprised of 16 patients in whom peri-anal fistulas and abscesses was diagnosed using endosonography. Conclusion: Endoscopic ultrasonography is a useful diagnostic test for lower GI tract diseases, and physicians should be familiar with its indications.

Introduction: Tuberculosis is a common disease in developing countries. Extra pulmonary tuberculosis with involvement of pancreas is rare. Abdominal pain especially in epigastrium, fever, night sweat, jaundice and weight loss with pancreatic mass especially in young people is suggestive of pancreatic tuberculosis.Case Report: We report a 51 year old lady with fever, epigastric pain and weight loss from 2 months prior to admission. On sonography and abdominal CT scan a mass lesion was seen in head and body of pancreas with lymph node involvement. Workup with CT guided BX of pancreatic tissue and laparatomy was done. Pathologic report showed granolumatous lesion with caseous necrosis in pancreatic lesion and lymph nodes compatible with tuberculosis.Conclusion: Patient was put on 4 anti tuberculosis therapy; response was good. Patient improved.

Background & Aims: The aims of this study were to represent the efficiency of Endoscopic Ultra Sonography in determining the place of insulinoma and assessment communication between tumor size and careful diagnosis of this method. Endoscopic ultra sonography is a method for determining the place of pancreatic tumor before a surgery.Materials & Methods: Suspected insulinoma patients based on clinical and laboratory entered in this study all of them underwent Endoscopic ultra sonography investigations before operation.Results: In 16 patients, (9 men and 7 women) with an average age of 52.5 years, sonography and then surgery was done. In all the patients CT scan as a supplementary recognition method was done. Sensitivity and specifity of endoscopic ultra sonography for identifying insulinoma was 70.58 and 60.6 percent and for tumor of head and body of pancreas was 83.3 and 66.6 percentConclusion: Endoscopic ultra sonography is an accurate method in order to identify insulinoma the accuracy of the method depends on the tumor site and is greater in tumors that locate in the head of pancreas.

Background: Endosonography is a distinct method in evaluating gastrointestinal (GI) structural lesions, particularly in the pancreatobiliary system. This procedure has made a fundamental change in the diagnosis of pancreatic mass lesions through fine needle aspiration (FNA). This study aims to evaluate the results and efficacy of endosonographic fine needle aspiration (EUS-FNA) in patients presenting with solid pancreatic masses.Methods: This was a descriptive, prospective, case series study of patients who presented with solid pancreatic masses to Imam Khomeini Hospital, Tehran, Iran over a one year period (from November 20092010-) In order to determine false negative cases, patients were followed for 6 to 12 months.Results: A total of 53 patients underwent EUS-FNA with no complications. The results were diagnostic in 46 (87%) cases. The majority of patients were male (68%) and 81% had a mass in the pancreatic head.Cytopathology results revealed 36 (68%) adenocarcinomas, 7 (13%) other malignancies, 3 (6%) benign lesions and 7 (13%) nondiagnostic cases.The frequency of nondiagnostic results was significantly more in masses smaller than 3 cm (6 vs.1, p<0.002).Patients with nondiagnostic results were younger than those with malignant cytopathologies (52±7.5 vs.66 ±7.5 years, p<0.001). Sensitivity, specificity, PPV, NPV and accuracy of EUS-FNA in adenocarcinoma cases were 88%, 100%, 100%, 70% and 90%, respectively.Conclusion: EUS-FNA is an effective and safe procedure in the histopathologic diagnosis of pancreatic tumors.

Introduction &Objective: Gastric Cancer (GC) is one of the most common causes of death in the world. The most important cause of high death rate related to GC is late diagnosis of the disease. The main treatment of gastric cancer in its primary stage of is surgery, and radiotherapy and chemotherapy are supplementary treatments. There are some factors that affect survival after surgery. This study aimed to assess the survival of patients with GC under surgery and to determine the risk factors of this cancer.Materials& Methods: A total of 262 patients with GC under surgery were followed and included in the study from 21st of March 2003 to 21st of March 2007 in the cancer institute of Tehran, Imam Khomeini Hospital, The staging of the disease before the surgery was based on CT-Scan and endosonography and after the surgery was based on the pathologic reports. The survival of the patients was determined by their periodical referrals and our telephone contacts with their relatives. The survival times were considered as the time from the diagnosis up to the death or the end of the study. The effect of the various risk factors including gender, age at diagnosis, tumor site, and pathologic stage of the disease, type of treatment, metastases and relapse were evaluated. Kaplan-Miere approach was used to estimate survival and Log-rank test and proportional Cox model to evaluate the related factors. Data were analyzed using Spss16 statistical software.Results: 75.2% of patients were men and 34.4% cases of patients experienced death. The mean follow-up time was 19.3±17.4. The mean age at diagnosis was 58±11.5 and survival mean and median were 49 and 27 months respectively. The one, three and five year survival of the patients was 0.85, 0.41 and 0.3 respectively. Gender, pathologic stage, age at diagnosis and weight-loss were significantly related to the survival in multivariate analysis.Conclusion: The diagnosis of the cancer in primary stages causes timely treatment and this in turn decreases the unpleasant outcomes of delayed diagnosis.

Background: Today the use of laparoscopy before laparotomy is an effective method for decision-making in patients with gastric adenocarcinoma. The reliance on CT scans for decision-making purposes is not only unhelpful, yet also misleading. Nonetheless, indications for laparoscopy and its application are changing daily. The low quality of diagnostic tools and epidemiological situation in our country requires that an independent study should be done in this case.Materials and Methods: All patients in the interval from the 12th month of 1388 until the 5th month of 1389 who were diagnosed as new cases of gastric adenocarcinoma and admitted to Shahid Sadoghy Hospital, Yazd, Iran were included in this experimental study.At first indication, laparoscopy was defined. All patients with complications who needed palliative surgery such as intolerable dysphagia, obstruction, bleeding or perforation in addition to those with distant metastases were excluded.TNM score and staging were noted for all patients.There were 26 patients who underwent laparoscopies to determine TNM scores and staging. These patients were divided into three groups: 1. Patients eligible for surgery with no neoadjuvant chemotherapy.2. Patients needing neoadjuvant chemotherapy prior to laparatomy.3. Non-operable patients, who only required chemotherapy.Subsequently, surgical pathological staging and TNM were determined for all 37 patients and used as the gold standard for comparison with other methods.Results: A total of 30 (88.9%) patients with the aid of CT scans were classified as stages I and II, where laparoscopy estimated six patients as stagesІ and ІІ, and surgical pathology diagnosed five (13.5%) cases out of the 37.The 37 patients were divided into the following groups: A-11 patients on clinical evaluation required laparotomy, but no laparoscopy was indicated.B-7 patients were identified as stages I and II who underwent surgery without neoadjuvant chemotherapy.C-8 patients were candidates for neoadjuvant chemotherapy after laparotomy.D-11 patients were estimated as inoperable and were only given chemotherapy.Of these, one patient was assumed to be operable with laparoscopy, yet was unoperable in laparatomy. Another patient did not receive neoadjuvant chemotherapy due to the lower estimation of laparoscopy.Conclusion: If patient management solely depended on the results of CT scans, therefore a total of 87% of patients were mismanaged. With laparoscopy, however, 30 patients (81%) were correctly managed whereas seven patients (19%) were not. There were five patients with surgical pathological stages I and II who did not benefit from laparoscopy and two patients were mismanaged because of incorrect laparoscopic information. No similarities with pathological and CT scan results according to TNM and staging were noted, so there was significant statistical difference.The results of TNM and staging scores of 30 patients who had laparoscopies were similar to the surgical TNM and staging scores, so there was no significant statistical difference Therefore, conventional CT scans are less sensitive than usuall in our city. Since access to multi-detector CT scans and endosonography is very difficult in our city, therefore we could not use them for better patient management which is a pitfall for this study.Thus, use of laparoscopy before laparotomy not only decrease the un necessary laparotomies rate, but also help us in selecting the patients who need neoadjuvant chemotherapy before surgery.

IntroductionPrimary gastric Glomus tumour is rare and much less frequent than gastrointestinal stromal tumors(GIST). at least 150 of them have been reported in articles, but no one had been published in Iran. Case reportPatient was a 59 years old man with the chief complains of sense of epigastric fullness after meal. Endosonography showed a hypoechoic mass in muscularis mucosa with 29×14 mm dimentions. patient underwent wedge resection of gastric tumour. In microscopy, sheets and nodules of round to polyhedral uniform cells with bland round to oval nuclei in the background of branched hemangiopericytoma-like vascular stroma with hyalinised wall were seen. Smooth Muscle Actin, desmin, chromogranin and CD117 were determined immunohistochemicaly, the first marker was positive and the reminders were negative. ConclusionPrimary gastric Glomus tumour is essentially a benign neoplasm, in order to prevent unnecessary radical surgery, its differentiation from others malignant lesions is mandatory.

Background and Objective: The staging of gastrointestinal cancer has an important role in the treatment of tumor. This study was done to determine the efficacy of endosonography method for determining the stage and deepth of esophagus and stomach cancers.Materials and Methods: In this descriptive study, endosonographic staging was performed in 23 patients (15 male and 8 female) with esophagus and stomach cancers, confirmed with pathologic findings in Taleghani hospital, Tehran, Iran during 2002-04. The results of surgical staging compared to preoperative endosonographic method.Results: Mean age of 23 patients was 57.2 years (43-72 years). 30% and 70% of the patients had esophageal and gastric cancers, respectively. The accuracy of endosonographic staging of esophagus and stomach cancers was 82%. The accuracy of diagnosis, positive and negative predictive value of cancers in assessment of the depth of the tumor by endosonography procedure was 79.4%, 69.6% and 84.9%, respectively.Conclusion: Endosonography is a precise method for evaluating depth and staging of tumor and lymph node involvement.