Depictability of the upper gastrointestinal tract on forward‐viewing radial endoscopic ultrasonography versus standard upper esophagogastroduodenoscopy

Abstract

Objectives Esophagogastroduodenoscopy (EGD) is a widely used modality for investigating the upper gastrointestinal (GI) tract, similar to endoscopic ultrasonography (EUS) for the pancreaticobiliary system. A recent and novel forward‐viewing radial EUS has potential as an EGD. However, this potential has not yet been evaluated and reported in the literature. We compared the depictability of the upper GI tract on EUS using a standard EGD. Methods This was a prospective study in a single session in an identical patient and it was conducted at a single center. Results Sixty‐nine participants were enrolled in this study. A forward‐viewing radial EUS revealed equivalent visualizing performance compared with the standard EGD, except for the retroflex view of the three angular areas. Depiction scores of the anterior wall, lesser curvature, and posterior wall of the angulus in the retroflex view in the forward‐viewing radial EUS were 1.94 (95% confidence interval [CI], 1.36–2.52), 2.03 (95% CI, 1.48–2.58), and 1.93 (95% CI, 1.35–2.50), respectively. These scores were significantly lower compared with those of standard EGD scores of 2.97 (95% CI, 2.86–3.08), 2.97 (95% CI, 2.86–3.78), and 2.96 (95% CI, 2.83–3.09], respectively; p < 0.001). The rate of full‐mark score in these three angular areas was significantly lower in the forward‐viewing radial EUS than in the standard EGD (21/69, 30.4%; 23/69, 33.3%; 21/69, 30.4% vs. 67/69; 97.1%, 67/69; 97.1%, 66/69; 95.7%, p < 0.001 for all). Conclusions Although forward‐viewing radial EUS has the potential to simultaneously investigate the upper GI and pancreaticobiliary systems, it is too early to introduce it for this purpose.

Utility of screening esophagogastroduodenoscopy performed sequentially with endoscopic ultrasonography

“…17 However, because the current dedicated EUS scope-even a forward-viewing EUS scope-is not suitable for gastric cancer screening, standard EGD should be used for screening EGD. 9 In this study, a protocol of sequential EGD and EUS using each dedicated scope was performed and detected gastric epithelial neoplasms at a non-negligible rate. However, this protocol may be more burdensome than EUS alone owing to the additional examination time (median, 7 min) and the fact that preparation and cleaning of additional endoscopes were required.…”

“…Although EUS is peroral endoscopy, the dedicated EUS scope is not suitable for gastric cancer screening for the two following reasons: rst, the dedicated EUS scope is commonly an oblique-viewing endoscope; and second, the dedicated EUS scope, even the forward-viewing EUS scope, reportedly has low depictability. 9 Therefore, EGD is crucial in gastric cancer screening for patients with pancreaticobiliary disease.…”