scholarly journals Endoscopic Ultrasonography-Guided Fine Needle Aspiration for Extrahepatic Cholangiocarcinoma: A Safe Tissue Sampling Modality

2019 ◽  
Vol 8 (4) ◽  
pp. 417 ◽  
Author(s):  
Takumi Onoyama ◽  
Kazuya Matsumoto ◽  
Yohei Takeda ◽  
Soichiro Kawata ◽  
Hiroki Kurumi ◽  
...  
Keyword(s):  
Endoscopic Ultrasonography ◽  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Biliary Disease ◽  
Tissue Sampling ◽  
Endoscopic Retrograde ◽  
Extrahepatic Cholangiocarcinoma ◽  
Fine Needle ◽  
Pathological Evaluation ◽  
Sensitivity Specificity

Few studies have compared the diagnostic utility of endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) and endoscopic retrograde cholangiopancreatography (ERCP) tissue sampling for extrahepatic cholangiocarcinoma (ECC). We evaluated the efficacy and safety of EUS-FNA for diagnosing ECC compared with ERCP tissue sampling. Patients who underwent EUS-FNA or ERCP tissue sampling to differentiate ECC from benign biliary disease were enrolled retrospectively between October 2011 and March 2017. We evaluated diagnostic performances of EUS-FNA and ERCP tissue sampling based on pathological evaluation. We compared adverse events in EUS-FNA and ERCP tissue sampling. We enrolled 73 patients with biliary disease and performed EUS-FNA and ERCP in 19 and 54 patients, respectively. Sensitivity, specificity, and accuracy of ERCP tissue sampling were 76.0%, 100%, and 88.9%, respectively, and for EUS-FNA these were 81.8%, 87.5%, and 84.2%, respectively. Statistical values of ERCP tissue sampling and EUS-FNA were not significantly different. The adverse event frequency of EUS-FNA was significantly lower than that of ERCP tissue sampling (0% vs. 25.9%, p = 0.033). The diagnostic ability of EUS-FNA for ECC is similar to that of ERCP tissue sampling. EUS-FNA is a safer tissue sampling modality than ERCP for evaluating biliary disease.

Pre-operative Diagnosis of Pancreatic Neuroendocrine Tumors with Endoscopic Ultrasonography and Computed Tomography in a Large Series

2016 ◽  
Vol 25 (3) ◽  
pp. 317-321 ◽  
Author(s):  
Raffaele Manta ◽  
Elisabetta Nardi ◽  
Nico Pagano ◽  
Claudio Ricci ◽  
Mariano Sica ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Neuroendocrine Tumors ◽  
Endoscopic Ultrasonography ◽  
Fine Needle Aspiration ◽  
Chromogranin A ◽  
Needle Aspiration ◽  
Large Series ◽  
Tumor Diameter ◽  
Pancreatic Neuroendocrine Tumors ◽  
Fine Needle

Background & Aims: Diagnosis of pancreatic neuroendocrine tumors (p-NETs) is frequently challenging. We describe a large series of patients with p-NETs in whom both pre-operative Computed Tomography (CT) and Endoscopic Ultrasonography (EUS) were performed. Methods: This was a retrospective analysis of prospectively collected sporadic p-NET cases. All patients underwent both standard multidetector CT study and EUS with fine-needle aspiration (FNA). The final histological diagnosis was achieved on a post-surgical specimen. Chromogranin A (CgA) levels were measured. Results: A total of 80 patients (mean age: 58 ± 14.2 years; males: 42) were enrolled. The diameter of functioning was significantly lower than that of non-functioning p-NETs (11.2 ± 8.5 mm vs 19.8 ± 12.2 mm; P = 0.0004). The CgA levels were more frequently elevated in non-functioning than functioning pNET patients (71.4% vs 46.9%; P = 0.049). Overall, the CT study detected the lesion in 51 (63.7%) cases, being negative in 26 (68.4%) patients with a tumor ≤10 mm, and in a further 3 (15%) cases with a tumor diameter ≤20 mm. CT overlooked the pancreatic lesion more frequently in patients with functioning than non-functioning p-NETs (46.5% vs 24.3%; P = 0.002). EUS allowed a more precise pre-operative tumor measurement, with an overall incorrect dimension in only 9 (11.2%) patients. Of note, the EUS-guided FNA suspected the neuroendocrine nature of tumor in all cases. Conclusions: Data of this large case series would suggest that the EUS should be included in the diagnostic work-up in all patients with a suspected p-NET, even when the CT study was negative for a primary lesion in the pancreas.– . Abbrevations: CgA: chromogranin A; EUS: Endoscopic Ultrasonography; FNA: fine-needle aspiration; p-NETs: pancreatic neuroendocrine tumors.

Endoscopic Ultrasonography

2018 ◽  
Author(s):  
Marvin Ryou ◽  
Nitkin Kumar
Keyword(s):  
Chronic Pancreatitis ◽  
Bile Duct ◽  
Endoscopic Ultrasonography ◽  
Fine Needle Aspiration ◽  
Biliary Drainage ◽  
Bile Duct Stone ◽  
Pancreatic Head ◽  
Needle Aspiration ◽  
Celiac Plexus ◽  
Fine Needle

Endoscopic ultrasonography (EUS) is a versatile tool that can be used to perform a variety of diagnostic and therapeutic procedures in the upper or lower gastrointestinal tract. The proximity of the echoendoscope to the pancreas, liver, and other thoracic and abdominal organs allows detailed examination or minimally invasive intervention that would not be feasible by surgical or percutaneous approaches. EUS is available with radial or linear scanning arrays and is capable of guiding fine-needle aspiration to acquire tissue for cytologic analysis. This review covers the role of EUS in chronic pancreatitis; pancreatic cysts; submucosal tumors; suspected choledocholithiasis; fecal incontinence; staging of malignancy in esophageal, pancreatic, gastric, and rectal cancer; celiac plexus block/neurolysis; fiducial placement; pseudocyst drainage and cystogastrostomy/cystoduodenostomy; endoscopic necrosectomy; and biliary drainage. Figures show peripancreatic cysts, gastrointestinal stromal tumor, common bile duct stone, esophageal adenocarcinoma, pancreatic head mass causing biliary obstruction and invading portal confluence, fine-needle aspiration of a pancreatic head mass, rectal adenocarcinoma, abdominal aorta with celiac artery and superior mesenteric artery, celiac plexus neurolysis, necrosectomy, and EUS-guided choledochoduodenostomy for failed endoscopic retrograde cholangiopancreatography. Tables list the Rosemont criteria for chronic pancreatitis and pancreatic cystic lesions.   Key words: bile duct stone, biliary drainage, echoendoscope, endoscopic ultrasonography, fine-needle aspiration, pancreatic cyst   This review contains 12 highly rendered figures, 2 tables, and 62 references.

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