Pancreato-Biliary School 2014
Pathomorphological aspects of pancreatic diseases. "School HPB surgery" Conference in Hospital No. 122 " (2014). Lector: S. Vorobyov.

Endoscopic Ultrasound (EUS)/Fine Needle Aspiration (FNA) for Pancreatic Leasures. "School HPB surgery" Conference in Hospital No. 122 " (2014). Lector: Dr. M. Burdukov.

Endoscopic ultrasound (EUS) is a technique using sound waves known as ultrasound during an endoscopic procedure to look at or through the wall of the gastrointestinal tract. Under continuous real-time ultrasound guidance, a thin needle can be advanced into these structures to obtain an aspirate of the tissue. This technique is known as a fine needle aspirate (FNA). The cells obtained from the FNA can be smeared on a slide and analyzed for abnormalities such as cancer. The cell analysis is called cytology.
EUS with FNA has revolutionized the ability to diagnose and stage pancreatic cancers. Abnormalities such as tumors and cysts of the pancreas can be carefully evaluated using EUS and then biopsied with FNA.

Endoscopic Ultrasound (EUS) for Pancreato-Biliary Diseases. Present Indications and future Directions.
"School HPB surgery" Conference in Hospital No. 122 " (2014). Lector: Dr. A. Larghi , ITALY

Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) has become the most accurate modality for characterization of pancreatic cystic and solid lesions, for differential diagnosis of indeterminate pancreatic masses and for locoregional staging of pancreatic and extrahepatic biliary tumours. EUS-FNA should also be performed in distant lymph nodes, ascites, liver, adrenal and mediastinal metastatic locations. Experienced groups reach a vey high sensitivity and specificity. Morbidity rate is very low. The performance of this technique is dependent on the endoscopist and cytopathologist experience, the location, size and consistency of the tumour and the number of passes in the lesion.

“Diagnostic Strategy in Pancreatic Tumors (Imaging) ” Lector: Dr. V.Ratnikov
"School HPB surgery" Conference in Hospital No. 122 " (2014).

Imaging studies that aid in the diagnosis of pancreatic cancer include the following:
• CT scanning
• Transcutaneous ultrasonography
• Endoscopic ultrasonography
• Magnetic resonance imaging
• Endoscopic retrograde cholangiopancreatography
• Positron emission tomography scanning

“Common Disorders of The Pancreas” Lector: Dr. L.Palgova
"School HPB surgery" Conference in Hospital No. 122 " (2014).

There are a variety of disorders of the pancreas including acute pancreatitis, chronic pancreatitis, hereditary pancreatitis, pancreatic cancer. The evaluation of pancreatic diseases can be difficult due to the inaccessibility of the pancreas. There are multiple methods to evaluate the pancreas. Initial tests of the pancreas include a physical examination, which is difficult since the pancreas is deep in the abdomen near the spine. Blood tests are often helpful in determining whether the pancreas is involved in a specific symptom but may be misleading. The best radiographic tests to evaluate the structure of the pancreas include CAT (computed tomography) scan, endoscopic ultrasound, and MRI (magnetic resonance imaging). Tests to evaluate the pancreatic ducts include ERCP (endoscopic retrograde cholangiopancreatography) and MRCP(magnetic resonance cholangiopancreatography). There are also instances in which surgical exploration is the only way to confirm the diagnosis of pancreatic disease.

The Tumors Of The Pancreato-Biliary Area. "School HPB surgery"

“The Tumors Of The Pancreato-Biliary Area." Lector: Dr. I.Rykov
"School HPB surgery" Conference in Hospital No. 122 " (2014).
Pancreato-biliary cancers are relatively uncommon and in general, including cancers arise from the pancreas, bile duct and major ampullae. These tumours are uniformly carried a poor prognosis due to late presentation. The aim of the lecture is to review and discuss current techniques and approaches to the management of pancreato- biliary neoplasm. The management of these patients is often complex and requires expertise in many fields. Thus, multidisciplinary teams are necessary to optimize the overall care. As the majority of these patients are diagnosed in advanced stages, good palliative care measures are essential to the management.

Imaging of Biliary Tract Disease "School HPB surgery"

“ Imaging of Biliary Tract Disease” Lector: Dr. V.Ratnikov
"School HPB surgery" Conference in Hospital No. 122 " (2014).
The technologies including endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiopancreatography (PTC), endoscopic ultrasound (EUS), intraductal ultrasonography (IDUS), magnetic resonance cholangiopancreatography (MRCP), helical CT (hCT) and helical CT cholangiography (hCTC) with regards to diagnostic performance characteristics, technical success, safety, and cost-effectiveness is reviewed.
Careful interrogation of the images is critical, regardless of modality. The identification of dilated bile ducts necessitates evaluation for strictures or filling defects, which is best performed with thin-section imaging. Improved diagnosis of biliary disease can be achieved with knowledge of the benefits and limitations of modern MR and CT cholangiographic techniques, including the use of biliary-excreted contrast material and of various postprocessing techniques. Familiarity with the radiologic appearances of the duct lumen, wall, and surrounding structures is also important for accurate image interpretation.

Endoscopy in the diagnosis of papilla Vateri diseases.

“ Endoscopy in the diagnosis of papilla Vateri diseases ” Lector: Dr. E.Solonitcin
"School HPB surgery" Conference in Hospital No. 122 " (2014).
Benign and malignant tumors of papilla Vateri are rare diagnoses in the endoscopic practice. Both ERCP and EUS are important tools in the evaluation and staging of ampullary adenomas and can assist in selecting candidates for endoscopic or surgical therapy. For malignant diseases surgical therapy should be considered if staging of tumor and general condition of the patient permits. In unresectable cases endoscopic palliation (papillotomy or polypectomy with or without drainage) can increase survival. In patients with benign tumors operative endoscopy followed by regular ultra-sonography and endoscopy seems to be necessary. Techniques of endoscopic removal of ampullary neoplasms are not standardized and should be performed by experienced endoscopists.

ERCP – Indications and Benefits. "School HPB surgery"

ERCP – Indications and Benefits. Lector: Dr. A. Dechen (Germany)
"School HPB surgery" Conference in Hospital No. 122 " (2014).
Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that uses a combination of luminal endoscopy and fluoroscopic imaging to diagnose and treat conditions associated with the pancreatobiliary system.

Cystic lesions of the pancreas. "School HPB surgery"

“Cystic lesions of the pancreas” Lector: Dr. E.Vasyucova
"School HPB surgery" Conference in Hospital No. 122 " (2014).
In the past two decades, the nature of many cystic tumors in this organ has been better characterized. The names of some existing entities were revised; for example, what was known as papillary-cystic tumor is now regarded as solid-pseudopapillary tumor. New entities, in particular, intraductal papillary mucinous neoplasm and its variants, such as oncocytic and intestinal subtypes were recognized. The importance of clinical and pathologic correlation in the evaluation of these lesions was appreciated, in particular, with regards to the multifocality of these lesions, their association with invasive carcinomas, and thus their 'preinvasive' nature.

Diagnosis of Cholestatic Disorders. "School HPB surgery"

“Diagnosis of cholestatic disorders “ Lector: Dr. K. Raykhelson
"School HPB surgery" Conference in Hospital №122 " (2014).
Cholestasis is known as an etiologically diverse clinical entity, which requires a broad differential diagnostic workup.
In the majority of patients, history, clinical examination, clinical chemical analysis, and abdominal ultrasound enable the differentiation between extrahepatic and intrahepatic cholestasis. This lecture summarizes our current knowledge in the diagnosis of cholestatic disorders.
In intrahepatic cholestasis (without bile duct dilatation at ultrasonography), the workup will include blood tests for liver disease and liver biopsy will be discussed case by case. In extrahepatic cholestasis (with bile duct dilatation at ultrasonography), a multidisciplinary approach will involve the radiologist, the surgeon, as well as the endoscopist, and delineate the role of magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP).