Fine needle aspiration using forward-viewing endoscopic ultrasonography

 

 Buy Article Permissions and Reprints

Background and study aim: A prototype forward-viewing instrument has been developed for therapeutic endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA). We had the opportunity to use this forward-viewing echo endoscope and to study its clinical usefulness, mainly for diagnostic EUS-FNA.

Patients and methods: The prototype forward-viewing echo endoscope was used for 15 months between November 2006 and March 2010, in a study group comprising 47 consecutive patients. Diagnostic EUS-FNA was done in 38 patients and the diagnostic accuracy of the forward-viewing device was compared with that from an oblique-viewing echo endoscope in reference patients who were matched by disease and puncture route. Therapeutic EUS was done in nine patients (pseudocyst drainage in six; celiac ganglia neurolysis, biliary drainage, and pancreatic duct drainage in one each).

Results: Diagnostic EUS-FNA provided a correct diagnosis in 97.4 % (37/38 patients), which was not significantly different from the 94.7 % (36/38) in the reference patients. Lesions considered difficult to access with an oblique-viewing scope, such as those located at the fornix, or the head of the pancreas, or associated with strictures, were easily punctured, as were those located at the body or tail of the pancreas or at the porta hepatis. Treatment was successful in all nine patients who underwent therapeutic EUS procedures. None of the 47 patients had any complications.

Conclusions: A forward-viewing echo endoscope that allows target sites to be punctured more perpendicularly with minimal effort, can be used for diagnostic EUS-FNA and this may be advantageous, depending on the site of target lesions.

References

• 1 Vilmann P, Jacobsen G K, Henriksen F W et al. Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease.  Gastrointest Endosc. 1992;  38 172-173
  CrossrefPubMedGoogle Scholar
• 2 Grimm H, Binmoeller K F, Soehendra N. Endosonography-guided drainage of a pancreatic pseudocyst.  Gastrointest Endosc. 1992;  38 170-171
  CrossrefPubMedGoogle Scholar
• 3 Kida M. Pancreatic masses.  Gastrointest Endosc. 2009;  69 102-109
  CrossrefPubMedGoogle Scholar
• 4 Seewald S, Ang T L, Kida M et al. EUS2008 Working Group document: evaluation of EUS-guided drainage of pancreatic-fluid collections.  Gastrointest Endosc. 2009;  69 13-21
  PubMedGoogle Scholar
• 5 Kida M, Itoi T. Current status and future perspective of interventional endoscopic ultrasound in Japan.  Digest Endosc. 2009;  21 50-52
  CrossrefPubMedGoogle Scholar
• 6 Wiersema M J, Wiersema L M. Endosonography-guided celiac plexus neurolysis.  Gastrointest Endosc. 1996;  44 656-662
  CrossrefPubMedGoogle Scholar
• 7 Irisawa A, Takagi T, Kanazawa M et al. EUS-guided fine-needle injection of immature dendritic cells into advanced cancer refractory to gemcitabine: a pilot study.  Pancreas. 2007;  35 189-190
  CrossrefPubMedGoogle Scholar
• 8 Chang K J. EUS-guided fine needle injection (FNI) and anti-tumor therapy.  Endoscopy. 2006;  38 (Supply 1) 88-93
  Article in Thieme ConnectPubMedGoogle Scholar
• 9 Posner M, Chang K J, Rosemurgy A et al. Multi-center phase 2/3 randomized controlled trial using TNFerade TM gene delivery combined with chemoradiation in patients with locally advanced pancreatic cancer. ASCO annual meeting; 2007
  Google Scholar
• 10 Voermans R P, Eisendrath P, Bruno M J et al. Initial evaluation of a novel prototype forward-viewing US endoscope in transmural drainage of pancreatic pseudocysts.  Gastrointest Endosc. 2007;  66 1013-1017
  CrossrefPubMedGoogle Scholar
• 11 de Lusong M A, Shah J N, Soetikno R et al. Treatment of a completely obstructed colonic anastomotic stricture by using a prototype forward-array echoendoscope and facilitated by SpyGlass.  Gastrointest Endosc. 2008;  68 988-992
  CrossrefPubMedGoogle Scholar
• 12 Trevino J M, Varadarajulu S. Initial experience with the prototype forward-viewing echoendoscope for therapeutic interventions other than pancreatic pseudocyst drainage.  Gastrointest Endosc. 2009;  69 361-365
  CrossrefPubMedGoogle Scholar
• 13 Wallace M B. Take NOTES (natural orifice transluminal endoscopic surgery).  Gastroenterology. 2006;  131 11-12
  CrossrefPubMedGoogle Scholar

M. Kida

Department of Gastroenterology
Kitasato University East Hospital

2-1-1 Asamizodai, Sagamihara
Kanagawa 228-8520
Japan

Fax: +81-42-7498690

Email: m-kida@kitasato-u.ac.jp