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Background: Etiology of acute pancreatitis (AP) remains idiopathic in 30% of patients. Endoscopic ultrasound (EUS) has been shown to increase the diagnostic yield in patients with idiopathic AP (IAP). Aim: The aim of this study was to evaluate the role of EUS in achieving etiological diagnosis in patients with IAP. Materials and Methods: Consecutive 192 patients with IAP were evaluated prospectively with EUS over a period of 2 years. Patients who had no etiological diagnosis for AP after detailed history, clinical examination, laboratory investigations, and magnetic resonance cholangiopancreatography were included in the study. Results: The mean age of patients was 34.6 ± 12 and male:female ratio was 2.1:1. Of these, 135 patients had gallbladder intact (Group A) and 57 patients had undergone cholecystectomy (Group B). In Group A, EUS identified a possible cause in 79 (58.5%) patients; microlithiasis (n = 48), chronic pancreatitis (CP) (n = 23), common bile duct (CBD) and gallbladder stone (n = 3), pancreatic divisum (n = 3), small pancreatic tumor (n = 1), and anomalous pancreaticobiliary junction (n = 1). In Group B, EUS yielded diagnosis in 28 (49.1%) patients; CP (n = 22), ascariasis (n = 3), CBD stone (n = 2), and pancreatic divisum (n = 1). Overall EUS helped in achieving etiological diagnosis in 107 (55.1%) of patients with IAP. The presence of intact gallbladder showed a tendency for increased diagnostic yield (P = 0.06). Conclusion: EUS is a useful modality to establish the diagnosis in IAP and this technique should be incorporated in the evaluation of IAP. [ABSTRACT FROM AUTHOR]

Background: There is very limited literature on results of fine needle aspiration (FNA) of small (defined as ≤1 cm at long and short axis) lymph nodes, particularly in the setting of pyrexia of unknown origin (PUO). Methods: The study was conducted from July 2014 to December 2015 at a tertiary care center. A total of 34 endoscopic ultrasound (EUS)-guided FNAs in 33 patients were done for lymph nodes =1 cm at long and short axis and these were included in the analysis. Results: The study cohort comprised 33 patients; 23 males and 10 females, mean age of 58 ± 12 years. Indication of FNA was to look for malignancy (n = 15), PUO (n = 16), unexplained weight loss (n = 1), and presence of lymphadenopathy in prospective liver donor (n = 1). The FNA was taken from mediastinal nodes (n = 20, 14 subcarinal) and abdominal (n = 14, 8 at porta). The mean size of lymph nodes was 87 ± 11 mm at large axis and 68 ± 17 mm at short axis. A total of 3 (8.8%) FNAs were nondiagnostic (inadequate material). The cytopathologic diagnosis was malignancy in 8 (23.5%), granulomatous change in 8 (23.5%), and reactive lymphadenopathy in 15 (44.1%). Thus, EUS-guided FNA of these small nodes changed the management decisions in 44% of cases (one patient had tubercular lymphadenopathy at two sites). The 22-gauge EUS FNA needle was used in majority of patients (n = 26). There was no significant difference between pathologic (malignant and granulomatous) and reactive lymph nodes regarding size at long or short axis, ratio of long and short axis, hypoechogenicity, and sharply defined borders. Conclusion: EUS-guided FNA of small lymph nodes showed pathological enlargement in 44% of cases. [ABSTRACT FROM AUTHOR]

Pancreatic pseudocyst is a well-known complication of both acute and chronic pancreatitis. It is a collection of fluid due to acute or chronic inflammation of pancreas or from injury. A pseudocyst with mediastinal extension is a rare entity. There are only few reports of endoscopic transesophageal drainage of mediastinal pseudocysts. We present a case of mediastinal pseudocyst in a 45-year-old male who presented with dysphagia, weight loss, fever, and productive cough which was managed endoscopically by endoscopic ultrasound-guided transesophageal aspiration. [ABSTRACT FROM AUTHOR]

A 50-year-old male came to us with pain abdomen; endoscopic ultrasound (EUS) made a diagnosis of cholecystoduodenal fistula which was later on confirmed on gastroscopy and surgery. We present interesting images of EUS; a calculus is visualized outside gallbladder with inflammatory changes of duodenal wall. [ABSTRACT FROM AUTHOR]