Forward-viewing echoendoscope versus standard echoendoscope for endoscopic ultrasound-guided tissue acquisition of solid lesions: a randomized, multicenter study

Endoscopy ◽  
2018 ◽  
Vol 51 (05) ◽  
pp. 444-451 ◽  
Author(s):  
Alberto Larghi ◽  
Mostafa Ibrahim ◽  
Lorenzo Fuccio ◽  
Selma Lekkerkerker ◽  
Pierre Eisendrath ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Diagnostic Accuracy ◽  
Endoscopic Ultrasound ◽  
Diagnostic Yield ◽  
Ultrasound Guided ◽  
Tissue Acquisition ◽  
And Performance ◽  
Subepithelial Lesions ◽  
Sensitivity Specificity ◽  
Solid Lesions

Abstract Background A forward-viewing linear (FVL) echoendoscope has been developed with the aim of overcoming some of the limitations of standard curved linear-array (CLA) echoendoscopes. There are no existing studies comparing the performance of the two echoendoscopes for endoscopic ultrasound-guided tissue acquisition (EUS-TA) of solid lesions other than subepithelial lesions. Methods This was a prospective, multicenter, randomized trial with a noninferiority design comparing FVL vs. CLA echoendoscopes in patients with solid lesions of the gastrointestinal tract or adjacent organs. Primary outcomes were successful identification of the lesion and success of EUS-TA. Secondary outcomes were safety, sensitivity, specificity, and diagnostic accuracy of the two different scopes for EUS-TA. Results 126 patients with solid lesions were randomly assigned to the CLA group (63 patients) or the FVL group (63 patients). The two groups were homogeneous with no differences in terms of needle type used, mean number of passes, and site of EUS-TA. No differences were observed between the FVL vs. CLA scopes in identification of the lesion (96.8 % vs. 98.4 %; P > 0.99) and technical success of EUS-TA (92.1 % vs. 96.8 %; P = 0.44). No adverse events occurred. Overall, diagnostic accuracy (77.8 % vs. 84.1 %), sensitivity (76.6 % vs. 84.1 %), and specificity (81.3 % vs. 84.2 %) did not differ between the two groups. Conclusions Our results strongly suggest that the FVL echoendoscope is noninferior to the CLA scope for the detection and performance of EUS-TA in patients with solid lesions of the gastrointestinal tract and adjacent organs. In addition, the FVL scope has the same diagnostic yield, accuracy, and safety as the CLA scope.

scholarly journals Diagnostic yield of endoscopic ultrasound-guided tissue acquisition for small solid pancreatic lesions

2020 ◽  
Vol 08 (10) ◽  
pp. E1359-E1364
Author(s):  
Takafumi Mie ◽  
Takashi Sasaki ◽  
Ryo Kanata ◽  
Takaaki Furukawa ◽  
Tsuyoshi Takeda ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Diagnostic Yield ◽  
Fine Needle Biopsy ◽  
Needle Aspiration ◽  
Pancreatic Abscess ◽  
Ultrasound Guided ◽  
Predictive Values ◽  
Fine Needle ◽  
Tissue Acquisition ◽  
Sensitivity Specificity

Abstract Background and study aims Endoscopic ultrasound (EUS)-guided tissue acquisition is sometimes required to diagnose small solid pancreatic lesions. The aim of this study was to evaluate the diagnostic yield of EUS-guided tissue acquisition for small solid pancreatic lesions and the differences in diagnostic yield among different needles. Patients and method We retrospectively analyzed consecutive patients who had undergone EUS-guided tissue acquisition for solid pancreatic lesions less than 2 cm between November 2012 and June 2019. Three types of needles were evaluated in this study: a 22-gauge fine-needle aspiration (FNA) Lancet needle, a 20-gauge fine-needle biopsy (FNB) Menghini needle with a lateral forward bevel, and a 22-gauge FNB Franseen needle. We evaluated the diagnostic yield and safety of the procedure using these needles. Results We analyzed 160 patients with 163 lesions. The overall sensitivity, specificity, and accuracy were 92.0 %, 100 %, and 92.6 %, respectively. In the histological plus cytological diagnosis, accuracies of the Lancet, Menghini, and Franseen needles were 92.7 %, 97.0 %, and 85.7 %, respectively (P = 0.10). In the histological diagnosis alone, the negative predictive values (NPVs) of the Lancet, Menghini, and Franseen needles were 13.3 %, 53.3 %, and 27.3 %, respectively (P = 0.08). Adverse events occurred in four cases (2.5 %): one postprocedural bleeding, two cases of pancreatitis, and one pancreatic abscess. Conclusions EUS-guided tissue acquisition for small solid pancreatic lesions has a high diagnostic yield and safety. This study suggested a difference in the diagnostic yield of each needle for small solid pancreatic lesions.

scholarly journals Macroscopic onsite evaluation using endoscopic ultrasound fine needle biopsy as an alternative to rapid onsite evaluation

2019 ◽  
Vol 07 (02) ◽  
pp. E189-E194 ◽  
Author(s):  
En-Ling Leung Ki ◽  
Anne-Isabelle Lemaistre ◽  
Fabien Fumex ◽  
Rodica Gincul ◽  
Christine Lefort ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Predictive Value ◽  
Needle Biopsy ◽  
Final Diagnosis ◽  
Fine Needle Biopsy ◽  
Fine Needle ◽  
Tissue Acquisition ◽  
Site Evaluation ◽  
Sensitivity Specificity ◽  
Solid Lesions

Abstract Background and aims This study aimed to evaluate the performance of Macroscopic On-site Evaluation (MOSE) using a novel endoscopic ultrasound (EUS) fine needle biopsy (FNB) needle (22-G Franseen-tip needle, Acquire, Boston Scientific Incorporated, Boston, Massachusetts, United States), and without using Rapid On-Site Evaluation (ROSE). Method Between May 2016 and August 2016, all consecutive patients referred to our center for EUS tissue acquisition (TA) for solid lesions underwent EUS-FNB with the 22-G Franseen-tip needle unless contra-indicated. The operator performed MOSE. If no macroscopic core was visualized, a second pass was performed. The final diagnosis was defined as unequivocal histology from EUS-TA with compatible 18 months follow-up, surgical resection, or both. We retrospectively analyzed the performance of MOSE. Results A total of 46 consecutive patients was included, and 54 solid lesions were biopsied. The endosonographer visualized core tissue in 93 % (50/54) of targets with a single pass, of which the pathologist confirmed histologic core fragments in 94 % (47/50). Four lesions required two passes, and the overall correlation between MOSE and histologic core fragments was 94 % (48/51). Diagnostic adequacy was 98 % (53/54) with one biliary target biopsied without significant material. The overall diagnostic accuracy was 94 %. Sensitivity, specificity, positive predictive value, and negative predictive value for malignancy were 92 %, 100 %, 100 %, and 81 %, respectively. No adverse events were reported. Conclusion Our study demonstrated that MOSE using the 22-G Franseen-tip needle could limit needle passes by accurately estimating histologic core fragments. It also demonstrated that high diagnostic adequacy and accuracy of > 90 % could be achieved without ROSE.

scholarly journals Endoscopic ultrasound-guided tissue sampling of small subepithelial tumors of the upper gastrointestinal tract with a 22-gauge core biopsy needle

2017 ◽  
Vol 05 (03) ◽  
pp. E165-E171 ◽  
Author(s):  
Christoph Schlag ◽  
Christoph Menzel ◽  
Manuela Götzberger ◽  
Simon Nennstiel ◽  
Peter Klare ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Endoscopic Ultrasound ◽  
Core Biopsy ◽  
Diagnostic Yield ◽  
Upper Gastrointestinal Tract ◽  
Tissue Sampling ◽  
Ultrasound Guided ◽  
Biopsy Needle ◽  
Upper Gastrointestinal ◽  
Subepithelial Tumors

Abstract Background and study aims The optimal approach to small subepithelial tumors (SETs) of the upper gastrointestinal tract remains inconclusive. The aim of this study was to evaluate endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for less invasive tissue sampling of small SETs of the upper gastrointestinal tract. Patients and methods In this prospective observational study patients with small ( ≤ 3 cm) SETs of the upper gastrointestinal tract were eligible and underwent EUS-FNB with a 22-gauge core biopsy needle. The main outcome measure was the diagnostic yield. The number of obtained core biopsies was also assessed. Results Twenty patients were included. The mean SET size was 16 mm (range 10 – 27 mm). EUS-FNB was technically feasible in all cases and no complications were observed. The diagnostic yield was 75 %. Core biopsy specimens were obtained in only 25 % of cases. Conclusion EUS-FNB with a 22-gauge core biopsy needle of small SETs can achieve a definite diagnosis in the majority of cases. However, because core samples cannot regularly be obtained, EUS-FNB seems not to be convincingly superior to standard EUS-FNA in this setting

scholarly journals Diagnostic Performance of Endoscopic Ultrasound-Guided Tissue Acquisition by EUS-FNA versus EUS-FNB for Solid Pancreatic Mass Without ROSE: A Retrospective Study.

2021 ◽  
Author(s):  
Thanawin Wong ◽  
Tanawat Pattarapuntakul ◽  
Nisa Netinatsuton ◽  
Bancha Ovartlarnporn ◽  
Jaksin Sottisuporn ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Diagnostic Performance ◽  
Diagnostic Yield ◽  
Pancreatic Mass ◽  
Procedure Time ◽  
Ultrasound Guided ◽  
Total Procedure Time ◽  
Tissue Acquisition ◽  
The Mean ◽  
Total Procedure

Abstract Background: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is an established diagnostic procedure for solid pancreatic mass. However, the diagnostic yield between fineneedle aspiration (FNA) and fine-needle biopsy (FNB) remains unclear. Thus, we aimed to evaluate and compare the diagnostic yields between FNA and FNB using conventional FNA and Franseen needles of the same size (22 gauge), respectively, in patients with solid pancreatic mass who underwent EUS-TA without rapid onsite cytopathology evaluation (ROSE). Methods: All cases of EUS-TA by FNA or FNB for solid pancreatic mass between January 2017 and October 2020 in a single center university hospital were retrospectively reviewed. The procedure was performed without an onsite cytologist. After macroscopic onsite evaluation (MOSE), the endoscopist finished the procedure. The diagnostic yield and the average number of needle passes between FNB and FNA were then compared. Results: A total of 151 patients (FNA, n = 77; FNB, n = 74) with solid pancreatic mass detected by cross-sectional imaging underwent EUS-TA. The mean age was 62.3 ± 12.8 years, with 88 (58.3%) males. Age, gender, mass location, tumour size and disease stage from imaging were not significantly different. The diagnostic performance was dramatically higher in EUS-FNB (100%) than in EUS-FNA (89.6%). The mean number of needle passes was clearly fewer in FNB than FNA (2.8 vs. 3.8, p < 0.001). The total procedure time was less in FNB (34.7 minutes) than in FNA (41 minutes). The adverse event rate between FNB and FNA was not significantly different. Conclusions: The diagnostic performance for solid pancreatic mass without ROSE was significantly higher in FNB than in FNA. The number of needle passes and the total procedure time was also lesser in FNB.

scholarly journals A Pilot Randomized Crossover Trial of Wet Suction and Conventional Techniques of Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Upper Gastrointestinal Subepithelial Lesions

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Mika Takasumi ◽  
Takuto Hikichi ◽  
Minami Hashimoto ◽  
Jun Nakamura ◽  
Tsunetaka Kato ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Crossover Trial ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
Randomized Crossover Trial ◽  
Subepithelial Lesions ◽  
Solid Lesions

Background and Aim. A wet suction technique (“wet” technique) has been developed to improve the quality of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for sampling various solid lesions. However, no studies have reported on the wet technique for EUS-FNA for gastrointestinal (GI) subepithelial lesions (SELs). We conducted a pilot randomized crossover trial to explore whether the wet technique could be useful with regard to tissue adequacy of upper GI-SELs (UGI-SELs) compared to the conventional EUS-FNA technique (“dry” technique). Methods. Twenty-six patients with UGI-SELs indicated for EUS-FNA were randomly assigned to the dry-first arm using the dry technique for the first two passes or the wet-first arm using the wet technique for the first two passes using a cross-over design with a ratio of 1 : 1. The primary endpoint was the cellularity score of the EUS-FNA specimens rated on a 4-point scale (0-3). The secondary endpoints were the factors influencing cellularity in each suction technique. Results. The mean cellularity score was 1.65 ± 1.20 for the wet technique and 2.00 ± 0.98 for the dry technique ( p = 0.068 ). Logistic regression analysis showed that higher cellularity may be related to the final diagnosis of gastrointestinal stromal tumors in the dry technique and the SEL location in the upper stomach in the wet technique. Conclusion. The wet EUS-FNA technique failed to show a potential for improved cellularity of specimens compared to the dry technique for UGI-SELs.

scholarly journals Diagnostic Yields of Endoscopic Ultrasound-Guided Fine-Needle Tissue Acquisition according to the Gastric Location

2020 ◽  
Author(s):  
Dong Hyun Kim ◽  
Chang-Hwan Park ◽  
Seon-Young Park ◽  
Eunae Cho ◽  
Hyun Soo Kim ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Diagnostic Yield ◽  
English Literature ◽  
Gastric Antrum ◽  
Gastric Body ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
Common Location ◽  
Common Diagnosis ◽  
Tissue Acquisition

Abstract AimThe histologic diagnosis of sub-epithelial tumors (SETs) in stomach has been achieved via endoscopic or surgical resection. We evaluated the efficacy of endoscopic ultrasound-guided fine-needle tissue acquisition (EUS-FNTA) for the diagnosis of gastric SETs according to the gastric location.MethodThirty-three patients diagnosed with gastric SETs via EUS-FNTA from January 2016 to May 2018 were analyzed retrospectively. Demographic characteristics, diagnostic yields and complications were evaluated.ResultsNineteen patients (57.6%) were female, with a median age of 57.7 years. EUS revealed a mean longitudinal diameter of 25.6 mm. The most common location of SETs was gastric body (n = 18, 54.5%), followed by cardia and fundus (n = 10, 30.3%), and antrum (n = 5, 15.2%). Twenty-gauge biopsy needle was used most frequently (90.9%). The diagnostic yield was obtained in 23 patients (69.7%). The most common diagnosis was gastrointestinal stromal tumor (69.5%), followed by leiomyoma (13.0%), and ectopic pancreas (8.7%). The diagnostic yield of SETs in gastric antrum (0/5, 0%) was significantly lower than in the gastric body and cardia (23/28, 82.1%, p = 0.001). A case of immediate bleeding after EUS-FNTA occurred in one patient (3.0%) who recovered uneventfully. According to studies reported in English literature, the overall diagnostic yield of SETs in gastric antrum was significantly lower than in the gastric body, fundus, and cardia (29.7% vs. 71.4%, p < 0.001, n = 191)ConclusionsAlthough EUS-FNTA is an advanced diagnostic tool for gastric SETs, it is essential to develop more effective methods for the diagnosis of antral SETs.

Tissue acquisition for diagnosis of biliary strictures using peroral cholangioscopy or endoscopic ultrasound-guided fine-needle aspiration

Endoscopy ◽  
2018 ◽  
Vol 51 (01) ◽  
pp. 50-59 ◽  
Author(s):  
Yun Lee ◽  
Jong Moon ◽  
Hyun Choi ◽  
Hee Kim ◽  
Hyun Lee ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Diagnostic Yield ◽  
Needle Aspiration ◽  
Biliary Strictures ◽  
Ultrasound Guided ◽  
Forceps Biopsy ◽  
Fine Needle ◽  
Peroral Cholangioscopy

Abstract Background Although endoscopic retrograde cholangiopancreatography (ERCP) is a first-line diagnostic modality for suspected malignant biliary stricture (MBS), the diagnostic yield of ERCP-based tissue sampling is insufficient. Peroral cholangioscopy-guided forceps biopsy (POC-FB) and endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) are evolving as reliable diagnostic procedures for inconclusive MBS. This study aimed to evaluate the usefulness of a diagnostic approach using POC-FB or EUS-FNAB according to the stricture location in patients with suspected MBS. Methods Consecutive patients diagnosed with suspected MBS with obstructive jaundice and/or cholangitis were enrolled prospectively. ERCP with transpapillary forceps biopsy (TPB) was performed initially. When malignancy was not confirmed by TPB, POC-FB using a SpyGlass direct visualization system or direct POC using an ultraslim endoscope was performed for proximal strictures, and EUS-FNAB was performed for distal strictures as a follow-up biopsy. Results Among a total of 181 patients, initial TPB showed malignancy in 122 patients, and the diagnostic accuracy of initial TPB was 71.8 % (95 % confidence interval [CI] 65.3 % – 78.4 %]. Of the 59 patients in whom TPB was negative for malignancy, 32 had proximal biliary strictures and underwent successful POC. The remaining 27 patients had distal strictures and underwent successful EUS-FNAB. The accuracy of malignancy detection using POC-FB for proximal biliary strictures and EUS-FNAB for distal biliary strictures was 93.6 % (95 %CI 84.9 %−100 %) and 96.3 % (95 %CI 89.2 %−100 %), respectively. The overall diagnostic accuracy for the combination of TPB with either POC-FB for proximal strictures and EUS-FNAB for distal strictures was 98.3 % (95 %CI 95.9 %−100 %) and 98.4 % (95 %CI 95.3 %−100 %), respectively. Conclusions An approach using POC-FB or EUS-FNAB according to the stricture location may be useful in the diagnosis of suspected MBS.

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