Diagnostics

Research

19 pages, 6429 KiB

Open AccessArticle

Rare Pancreatic/Peripancreatic Cystic Lesions Can Be Accurately Characterized by EUS with Through-the-Needle Biopsy—A Unique Pictorial Essay with Clinical and Histopathological Correlations

by Maria Cristina Conti Bellocchi, Erminia Manfrin, Alessandro Brillo, Laura Bernardoni, Andrea Lisotti, Pietro Fusaroli, Alice Parisi, Sokol Sina, Antonio Facciorusso, Armando Gabbrielli and Stefano Francesco Crinò

Diagnostics 2023, 13(24), 3663; https://doi.org/10.3390/diagnostics13243663 - 14 Dec 2023

Cited by 1 | Viewed by 837

Abstract

Due to their aspecific macroscopic appearance, uncommon pancreatic cystic lesions (PCLs) are often misdiagnosed as mucinous lesions and improperly resected. We aimed to evaluate the endoscopic ultrasound (EUS)-guided through-the-needle biopsy (TTNB) capacity of the preoperative diagnosis of uncommon PCLs. Overall, 136 patients with [...] Read more.

Due to their aspecific macroscopic appearance, uncommon pancreatic cystic lesions (PCLs) are often misdiagnosed as mucinous lesions and improperly resected. We aimed to evaluate the endoscopic ultrasound (EUS)-guided through-the-needle biopsy (TTNB) capacity of the preoperative diagnosis of uncommon PCLs. Overall, 136 patients with PCLs who underwent EUS-TTNB between 2016 and 2022 were retrospectively identified. Common histotypes (e.g., IPMN, serous cystadenoma, and mucinous cystadenoma) were excluded and 26 (19.1%) patients (15 female, mean age 52.9 ± 10.4) were analyzed. The EUS findings, adverse events (AEs), and TTNB outcomes in uncommon PCLs were evaluated. The cysts histotype was accurately diagnosed by TTNB in 24/26 (92.3%) cases (seven cystic neuroendocrine tumors, four squamoid cysts, three acinar cells cystadenomas, two lymphoepithelial cysts, two mucinous non-neoplastic cysts, two bronchogenic cysts, two cystic lymphangiomas, one solid-pseudopapillary neoplasm, and one schwannoma). In the remaining two cases, lymphangioma was eventually diagnosed after resection. Surgery was performed in 15/26 (57.7%) patients. The mean follow-up of non-surgical patients was 32.5 months. One severe acute case of pancreatitis (3.8%) that required surgery occurred after EUS-TTNB. Uncommon pancreatic/peripancreatic lesions represent the 19.1% of PCLs in our series, with mainly benign histotypes. TTNB demonstrated a high diagnostic performance with a low rate of AEs in this setting, representing a reliable tool with which to avoid useless surgery. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound Guided Tissue Sampling of Tumors)

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10 pages, 1469 KiB

Open AccessCommunication

Exploring the Optimal Timing of Endoscopic Ultrasound Performance Post-Acute Idiopathic Pancreatitis

by Tawfik Khoury, Amir Shahin and Wisam Sbeit

Diagnostics 2022, 12(8), 1808; https://doi.org/10.3390/diagnostics12081808 - 27 Jul 2022

Cited by 1 | Viewed by 1175

Abstract

Background: Patients with acute idiopathic pancreatitis (AIP) should undergo further imaging tests such as endoscopic ultrasound (EUS) for further investigation. The time interval between an episode of AIP and EUS performance is still controversial. Aims: We aimed to explore the optimal timing for [...] Read more.

Background: Patients with acute idiopathic pancreatitis (AIP) should undergo further imaging tests such as endoscopic ultrasound (EUS) for further investigation. The time interval between an episode of AIP and EUS performance is still controversial. Aims: We aimed to explore the optimal timing for performing EUS and to reveal parameters that might predict longer intervals needed for performing EUS. Methods: We performed a single-center retrospective study at Galilee Medical Center from January 2015 to January 2020, at which point we included all patients who underwent EUS for further investigation of AIP. Results: Overall, we included 50 patients. The average age of all patients was 54.2 ± 17.6 years (range 22–69 years), and more than half of the study cohort were males (58%). Classifying patients as inflamed vs. normal pancreatic tissue on EUS, we found that among patients with normal pancreatic tissue, EUS was performed 44.7 ± 28.3 days from discharge, while for patients with inflamed pancreatic tissue, it was 48.1 ± 22.3 days (p = 0.37) after discharge. Notably, the CT severity index was significantly associated with inflamed pancreatic tissue on EUS, as it was 2.4 ± 0.74 vs. 1.5 ± 1.3 in the normal pancreatic tissue group (p = 0.03). There were no differences in the Bedside index for severity in acute pancreatitis (BISAP) scores, and there were no differences in the average American Society of Anesthesiologist Physical Status (ASA) scores between the two groups. Notably, 26.3% of patients had inflamed pancreatic tissue when performing EUS at 4 weeks, as compared to 16% who had inflamed pancreatic tissue at EUS performed after 6 weeks. Conclusion: Radiological severity score was the only important factor in determining the time interval of performing EUS after an episode of AIP. Intervals greater than six weeks seem to be needed among patients with higher Balthazar scores. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound Guided Tissue Sampling of Tumors)

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10 pages, 967 KiB

Open AccessArticle

Impact of Antibiotic Prophylaxis on Infection Rate after Endoscopic Ultrasound Through-the-Needle Biopsy of Pancreatic Cysts: A Propensity Score-Matched Study

by Antonio Facciorusso, Martha Arevalo-Mora, Maria Cristina Conti Bellocchi, Laura Bernardoni, Daryl Ramai, Paraskevas Gkolfakis, Domenico Loizzi, Nicola Muscatiello, Antonio Ambrosi, Nicola Tartaglia, Carlos Robles-Medranda, Elisa Stasi, Andrew Ofosu and Stefano Francesco Crinò

Diagnostics 2022, 12(1), 211; https://doi.org/10.3390/diagnostics12010211 - 16 Jan 2022

Cited by 3 | Viewed by 1787

Abstract

Background: Despite weak evidence, antibiotic prophylaxis prior to endoscopic ultrasound-guided through-the-needle biopsy (EUS-TTNB) of pancreatic cystic lesions (PCLs) is routinely used in clinical practice. We aim to compare a group of patients treated with antibiotics before EUS-TTNB of PCLs and a group who [...] Read more.

Background: Despite weak evidence, antibiotic prophylaxis prior to endoscopic ultrasound-guided through-the-needle biopsy (EUS-TTNB) of pancreatic cystic lesions (PCLs) is routinely used in clinical practice. We aim to compare a group of patients treated with antibiotics before EUS-TTNB of PCLs and a group who did not undergo antimicrobial prophylaxis. Methods: Out of 236 patients with pancreatic cystic lesions referred to two high-volume centers between 2016 and 2021, after propensity score matching, two groups were compared: 98 subjects who underwent EUS-TTNB under antibiotic prophylaxis and 49 subjects without prophylaxis. Results: There was no difference in terms of baseline parameters between groups. Final diagnosis was serous cystadenoma in 36.7% of patients in the group not treated with prophylaxis and in 37.7% of patients in the control group, whereas IPMN and mucinous cystadenoma were diagnosed in 3 (6.1%) and 16 (32.6%) versus 6 (6.1%) and 32 (32.6%) patients in the two groups, respectively (p = 0.23). Overall, the adverse event rate was 6.1% in the group not treated with antibiotic prophylaxis and 5.1% in the control group (p = 0.49). Only a single infectious adverse event occurred in each group (p = 0.48). The diagnostic yields were 89.7% and 90.8% in the two groups (p = 0.7), and the diagnostic accuracy rate was 81.6% in both groups (p = 1.0). Conclusions: Prophylactic antibiotics do not seem to influence the risk of infection, and their routine use should be discouraged. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound Guided Tissue Sampling of Tumors)

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10 pages, 1244 KiB

Open AccessArticle

Two Needle Passes Achieve Similar Diagnostic Yield Compared to Three Passes Regarding Diagnosis of Solid Pancreatic Lesions in Endoscopic Ultrasound-Guided Fine Needle Aspiration

by Eleni Koukoulioti, Georgios Tziatzios, Mario Tadic, Stavros Dimitriadis, Paraskevas Gkolfakis, Ekaterini Politi, Tajana Stoos-Veic, Petra Turcic, Alexandros Chatzidakis, Lazaros-Dimitrios Lazaridis, Maria Farmaki, Antonios Vezakis, Konstantinos Triantafyllou, Andreas Polydorou and Ioannis S. Papanikolaou

Diagnostics 2021, 11(12), 2272; https://doi.org/10.3390/diagnostics11122272 - 04 Dec 2021

Cited by 1 | Viewed by 1964

Abstract

Current guidelines advocate 3–4 passes with a fine-needle aspiration (FNA) to achieve high rates of diagnostic samples for malignancy when performing endoscopic ultrasound (EUS)-guided sampling of solid pancreatic lesions, in the absence of on-site cytologic evaluation. The aim of this study is to [...] Read more.

Current guidelines advocate 3–4 passes with a fine-needle aspiration (FNA) to achieve high rates of diagnostic samples for malignancy when performing endoscopic ultrasound (EUS)-guided sampling of solid pancreatic lesions, in the absence of on-site cytologic evaluation. The aim of this study is to compare 2 vs. 3 needle passes in EUS-FNA for solid pancreatic lesions in terms of incremental diagnostic yield and to identify factors associated with the procedure’s outcome. In this retrospective study, 2 passes of EUS-FNA were found to have similar diagnostic yield compared to 3 passes for the diagnosis of solid pancreatic masses, suggesting that there might be no significant incremental tissue yield when 3 passes are performed. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound Guided Tissue Sampling of Tumors)

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10 pages, 939 KiB

Open AccessArticle

EUS-Guided Biopsy with a Novel Puncture Biopsy Forceps Needle—Feasibility Study

by Geke Litjens, Christian Gerges, Yogesh M. Shastri, Piyush Somani, Torsten Beyna, Horst Neuhaus, Cornelis J. H. M. van Laarhoven, Mathias Prokop, Peter D. Siersema, John J. Hermans and Erwin J. M. van Geenen

Diagnostics 2021, 11(9), 1638; https://doi.org/10.3390/diagnostics11091638 - 07 Sep 2021

Cited by 3 | Viewed by 1782

Abstract

Endoscopic ultrasound (EUS) with fine needle aspiration (FNA) or biopsy (FNB) to diagnose lesions in the gastrointestinal tract is common. Demand for histology sampling to identify treatment-specific targets is increasing. Various core biopsy FNB needles to obtain tissue for histology are currently available, [...] Read more.

Endoscopic ultrasound (EUS) with fine needle aspiration (FNA) or biopsy (FNB) to diagnose lesions in the gastrointestinal tract is common. Demand for histology sampling to identify treatment-specific targets is increasing. Various core biopsy FNB needles to obtain tissue for histology are currently available, however, with variable (37–97%) histology yields. In this multicenter study, we evaluated performance, safety, and user experience of a novel device (the puncture biopsy forceps (PBF) needle). Twenty-four procedures with the PBF needle were performed in 24 patients with a suspected pancreatic lesion (n = 10), subepithelial lesion (n = 10), lymph node (n = 3), or pararectal mass (n = 1). In 20/24 (83%) procedures, the PBF needle yielded sufficient material for interpretation (sample adequacy). In 17/24 (71%), a correct diagnosis was made with the material from the PBF needle (diagnostic accuracy). All participating endoscopists experienced a learning curve. (Per)procedural technical issues occurred in four cases (17%), but there were no adverse events. The PBF needle is a safe and potentially useful device to obtain an EUS-guided biopsy specimen. As the design of the PBF needle is different to core biopsy FNB needles, specific training will likely further improve the performance of the PBF needle. Furthermore, the design of the needle needs further improvement to make it more robust in clinical practice. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound Guided Tissue Sampling of Tumors)

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9 pages, 931 KiB

Open AccessArticle

Effectiveness of EUS-Guided Fine-Needle Biopsy versus EUS-Guided Fine-Needle Aspiration: A Retrospective Analysis

by Naosuke Kuraoka, Satoru Hashimoto, Shigeru Matsui and Shuji Terai

Diagnostics 2021, 11(6), 965; https://doi.org/10.3390/diagnostics11060965 - 27 May 2021

Cited by 7 | Viewed by 3583

Abstract

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for pancreatic tumors and subepithelial lesions (SEL) of the gastrointestinal tract are effective for histological diagnosis. There are also reports that tissue sampling is possible with a smaller number of punctures by EUS-guided fine-needle biopsy (EUS-FNB). In this [...] Read more.

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for pancreatic tumors and subepithelial lesions (SEL) of the gastrointestinal tract are effective for histological diagnosis. There are also reports that tissue sampling is possible with a smaller number of punctures by EUS-guided fine-needle biopsy (EUS-FNB). In this study, we retrospectively compared the diagnostic abilities of EUS-FNA and EUS-FNB. We examined 130 patients who underwent EUS-FNA/EUS-FNB for pancreatic tumors and SEL from July 2018 to January 2021. None of the cases underwent rapid on-site evaluation. There were 94 and 36 cases in the EUS-FNA and EUS-FNB groups, respectively. The median tumor size in the EUS-FNB group was 30 mm, which was significantly larger than the EUS-FNA group (p = 0.02). In addition, transgastric puncture was significantly more common in the EUS-FNB group (p = 0.01). The EUS-FNA and EUS-FNB groups had a sensitivity of 82.9% and 91.7% and an accuracy rate of 85.1% and 91.7%, respectively. However, both procedures had a comparable diagnostic ability. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound Guided Tissue Sampling of Tumors)

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10 pages, 761 KiB

Open AccessArticle

Endoscopic Ultrasound Quality Metrics in Clinical Practice

by Lawrence Ku, Linda A. Hou, Viktor E. Eysselein and Sofiya Reicher

Diagnostics 2021, 11(2), 242; https://doi.org/10.3390/diagnostics11020242 - 04 Feb 2021

Cited by 2 | Viewed by 1847

Abstract

Recent advances in endoscopic ultrasound (EUS), particularly EUS-guided tissue acquisition, may have affected EUS procedural performance as measured by current American Society for Gastrointestinal Endoscopy (ASGE)/American College of Gastroenterology (ACG) quality indicators. Our study aims to assess how these quality metrics are met [...] Read more.

Recent advances in endoscopic ultrasound (EUS), particularly EUS-guided tissue acquisition, may have affected EUS procedural performance as measured by current American Society for Gastrointestinal Endoscopy (ASGE)/American College of Gastroenterology (ACG) quality indicators. Our study aims to assess how these quality metrics are met in clinical practice. We retrospectively analyzed 732 EUS procedures; data collected were procedural indications, technical aspects and outcomes, completeness of documentation, and malignancy staging. EUS was performed in 660 patients for a variety of indications. All ASGE/ACG EUS procedural quality metrics were met or exceeded. Intervention was successful in 97.7% (715/732) of cases, with complication rate of 0.4% (3/732). EUS outcomes changed clinical management in 58.7% of all cases and in 91.2% of malignancy work-up cases; in 26.0% of suspected choledocholithiasis cases, endoscopic retrograde cholangiopancreatography (ERCP) was avoided after EUS. Locoregional EUS staging was accurate in 61/65 (93.8%) cases of non-metastatic disease and in 15/22 (68.2%) cases of metastatic disease. Pancreatic mass malignancy detection rate with EUS-guided fine needle aspiration (FNA) or fine needle biopsy (FNB) was 75.8%, with a sensitivity of 96.2%; a significant increase in detection rate from 46.2% (6/13) to 95.0% (19/20) (p = 0.0026) was observed with a transition to the predominant use of FNB for tissue acquisition. All ASGE/ACG EUS quality metrics were met or exceeded for EUS procedures performed for a wide variety of indications in a diverse patient population. EUS was instrumental in changing clinical management, with a low complication rate. The malignancy detection rate in pancreatic masses significantly increased with FNB use. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound Guided Tissue Sampling of Tumors)

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10 pages, 2961 KiB

Open AccessArticle

Efficacy and Safety of Non-Anesthesiologist Administration of Propofol Sedation in Endoscopic Ultrasound: A Propensity Score Analysis

by Antonio Facciorusso, Antonio Turco, Carlo Barnabà, Grazia Longo, Graziano Dipasquale and Nicola Muscatiello

Diagnostics 2020, 10(10), 791; https://doi.org/10.3390/diagnostics10100791 - 06 Oct 2020

Cited by 3 | Viewed by 1779

Abstract

In spite of promising preliminary results, evidence supporting the use of non-anesthesiologist-administered propofol sedation (NAAP) in endoscopic ultrasound (EUS) procedures is still limited. The aim of this manuscript was to examine the safety and efficacy of NAAP as compared to anesthesiologist-administered propofol sedation [...] Read more.

In spite of promising preliminary results, evidence supporting the use of non-anesthesiologist-administered propofol sedation (NAAP) in endoscopic ultrasound (EUS) procedures is still limited. The aim of this manuscript was to examine the safety and efficacy of NAAP as compared to anesthesiologist-administered propofol sedation in EUS procedures performed in a referral center. Out of 832 patients referred to our center between 2016 and 2019, after propensity score matching two groups were compared: 305 treated with NAAP and 305 controls who underwent anesthesiologist-administered propofol sedation. The primary outcome was the rate of major complications. The median age was 67 years and the proportion of patients with comorbidities was 31.8% in both groups. One patient in each group (0.3%) experienced a major complication, whereas minor complications were observed in 13 patients in the NAAP group (4.2%) and 10 patients in the control group (3.2%; p = 0.52). Overall pain during the procedure was 2.3 ± 1 in group 1 and 1.8 ± 1 in group 2 (p = 0.67), whereas pain/discomfort upon awakening was rated as 1 ± 0.5 in both groups (p = 0.72). NAAP is safe and effective even in advanced EUS procedures. Further randomized-controlled trials (RCTs) are warranted to confirm these findings. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound Guided Tissue Sampling of Tumors)

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Review

Jump to: Research, Other

14 pages, 294 KiB

Open AccessReview

A Comprehensive Narrative Review on the Evolving Role of Endoscopic Ultrasound in Focal Solid Liver Lesions Diagnosis and Management

by Wisam Sbeit, Anas Kadah, Amir Mari, Mahmud Mahamid and Tawfik Khoury

Diagnostics 2020, 10(9), 688; https://doi.org/10.3390/diagnostics10090688 - 11 Sep 2020

Cited by 7 | Viewed by 2283

Abstract

The implications of endoscopic ultrasound (EUS) have expanded considerably in recent years to cover more fields in invasive gastroenterology practice, as both an investigative and therapeutic modality. The utility of EUS in the diagnosis and management of focal liver lesions has gained a [...] Read more.

The implications of endoscopic ultrasound (EUS) have expanded considerably in recent years to cover more fields in invasive gastroenterology practice, as both an investigative and therapeutic modality. The utility of EUS in the diagnosis and management of focal liver lesions has gained a special attractiveness recently. The EUS probe proximity to the liver and its excellent spatial resolution enables real-time images coupled with several enhancement techniques, such as contrast-enhanced (CE) EUS. Aside from its notable capability to execute targeted biopsies and therapeutic interventions, EUS has developed into a hopeful therapeutic tool for the management of solid liver lesions. Herein, we provide a comprehensive state-of-the-art review on the efficacy and safety of EUS in the diagnosis and management of focal solid liver lesions. Medline/PubMed and Embase database searches were conducted by two separate authors (T.K. and W.S.), all relevant studies were assessed, and relevant data was extracted and fully reported. EUS-guided diagnosis of focal liver lesions by sonographic morphologic appearance and cytological and histopathological finding of biopsies obtained via fine needle aspiration/biopsy have been shown to significantly improve the diagnosis of solid liver lesions compared with traditional imaging tools. Similarly, EUS-guided treatment has been shown to consistently have excellent technical success, high efficacy, and minor adverse events. The evolving valuable evidences of EUS utility might satisfy the unmet need of optimizing management of focal solid liver lesions. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound Guided Tissue Sampling of Tumors)

Other

Jump to: Research, Review

3 pages, 1005 KiB

Open AccessInteresting Images

Simplified Submucosal Tunneling Biopsy Using Clip-With-Line Traction and Closure for Gastric Subepithelial Lesion

by Hideki Kobara, Nobuya Kobayashi, Noriko Nishiyama, Naoya Tada, Shintaro Fujihara and Tsutomu Masaki

Diagnostics 2020, 10(9), 690; https://doi.org/10.3390/diagnostics10090690 - 12 Sep 2020

Cited by 1 | Viewed by 2091

Abstract

Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) has emerged as a standard and convenient method for the sampling of subepithelial lesions (SELs). Immunohistological analysis is required to definitively distinguish mesenchymal tumors; however, EUS-FNA provides insufficient material to achieve this, especially for small SELs [...] Read more.

Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) has emerged as a standard and convenient method for the sampling of subepithelial lesions (SELs). Immunohistological analysis is required to definitively distinguish mesenchymal tumors; however, EUS-FNA provides insufficient material to achieve this, especially for small SELs < 2 cm. We therefore previously reported a novel submucosal tunneling biopsy (STB) technique that utilizes endoscopic submucosal dissection (ESD) for sampling SELs. However, unresolved advanced technical issues have hindered its widespread application. Currently, a counter-traction technique is used to facilitate ESD. We here describe a technically simplified STB technique using clip-with-line traction for gastric SELs. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound Guided Tissue Sampling of Tumors)

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