Eus-Fna With 19 or 22 Gauges Needles for Gastric Subepithelial Lesions of the Muscle Layer

Lopes, César Vivian; Hartmann, A; Artifon, Everson Luiz de Almeida

doi:10.1590/0102-672020180001e1350

Cited by 10 publications

(9 citation statements)

References 25 publications

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“…Endoscopic resection must remove the tumor completely (R0 resection) 22,29 . To date, no recurrence has been observed after polypectomy/mucosectomy that affects the prognosis 20 .…”

Section: Resultsmentioning

confidence: 99%

The Role of Conventional Echoendoscopy (Eus) in Therapeutic Decisions in Patients With Neuroendocrine Gastrointestinal Tumors

Costa

Kemp

Santos

et al. 2020

ABCD, arq. bras. cir. dig.

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Background: Gastrointestinal neuroendocrine tumors are rare, usually presented as subepithelial or polypoid tumors. Accurate diagnosis and indication of the type of resection are still challenging. Aim: To determine the effectiveness of echoendoscopy in determining the depth of the lesions (T) identified by endoscopy in order to evaluate surgical and/or endoscopic indication, and to evaluate the results of endoscopic removal in the medium term. Methods: Twenty-seven patients were included, all of whom underwent echoendoscopy for TN tumor staging and the evaluation of possible endoscopic resection. The parameters were: lesion size, origin layer, depth of involvement and identified perilesional adenopathies. The inclusion criteria for endoscopic resection were: 1) high surgical risk; 2) those with NET <2 cm; 3) absence of impairment of the muscle itself; and 4) absence of perilesional adenopathies in echoendoscopy and in others without distant metastases. Exclusion criteria were TNE> 2 cm; those with infiltration of the muscle itself; with perilesional adenopathies and distant metastases. The techniques used were: resection with polypectomy loop; mucosectomy with saline injection; and mucosectomy after ligation with an elastic band. The anatomopathological study of the specimens included evaluation of the margins and immunohistochemistry (chromogranin, synaptophysin and Ki 67) to characterize the tumor. Follow-up was done at 1, 6 and 12 months. Results: Resections with polypectomy loop were performed in 15 patients; mucosectomy in five; mucosectomy and ligation with elastic band in three and the remaining four were referred for surgery. The anatomopathological specimens and immunohistochemical analyzes showed positive chromogranin and synaptophysin, while Ki 67 was less than 5% among all cases. The medium-term follow-up revealed three recurrences. The average size of tumors in the stomach was 7.6 mm and in the duodenum 7.2 mm. Well-demarcated, hypoechoic, homogeneous lesions occurred in 75%; mucous layer in 80%; and the deep and submucosal mucosa in 70%. Conclusions: Echoendoscopy proved to be a good method for the study of subepithelial lesions, being able to identify the layer affected by the neoplasm, degree of invasion, echogenicity, heterogeneity, size of the lesion and perilesional lymph node involvement and better indicate the treatment option.

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“…Endoscopic resection must remove the tumor completely (R0 resection) 22,29 . To date, no recurrence has been observed after polypectomy/mucosectomy that affects the prognosis 20 .…”

Section: Resultsmentioning

confidence: 99%

The Role of Conventional Echoendoscopy (Eus) in Therapeutic Decisions in Patients With Neuroendocrine Gastrointestinal Tumors

Costa

Kemp

Santos

et al. 2020

ABCD, arq. bras. cir. dig.

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“…Despite this increase in the number of puncture needle options, there is no one particular needle used uniformly. Regarding needle selection, needle size has also been discussed; needle size may be a confounder, as the potential usefulness of 19-gauge [ 25 , 26 , 27 ] and 25-gauge [ 28 ] puncture needles has been shown. Although a 19-gauge needle can provide sufficient tissue, the strong puncture resistance makes it very difficult to use a 19-gauge needle, especially for small lesions.…”

Section: Discussionmentioning

confidence: 99%

Franseen Needles May Be Promising for Improving the Sampling Adequacy of EUS-FNA for Subepithelial Lesions

Kasuga

Kurita

Tanida³

et al. 2022

Diagnostics

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Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is useful in diagnosing subepithelial lesions (SELs), and adequate tissue sampling is necessary to differentiate between benign and malignant diseases to determine therapeutic strategies. This study aimed to evaluate sampling adequacy and diagnostic performance of EUS-FNA for SELs with Franseen needles. This retrospective study enrolled 130 patients who underwent EUS-FNA with a 22-gauge needle for SELs from January 2010 to March 2021. We compared sampling adequacy and predictive factors influencing the sampling adequacy of EUS-FNA for SELs between Franseen and conventional needles. The sampling adequacy rates were 95.0% (38/40) with Franseen needles and 76.7% (69/90) with conventional needles (p = 0.011). The mean number of punctures with Franseen needles (2.80) was significantly less than that with conventional needles (3.42) (p < 0.001). In the multivariate analysis, the use of Franseen needles (p = 0.029; odds ratio [OR], 5.37; 95% confidence interval [CI], 1.18–23.36) was an independent factor influencing the sampling adequacy. Compared to conventional needles, the Franseen needle could play a vital role in accurately diagnosing SELs by yielding better sampling adequacy and reducing the number of passes.

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“…Massive studies have already been published regarding the diagnostic yield of EUS-FNAB. 22 - 56 A meta-analysis published in 2016 reports that EUS-guided sampling of upper gastrointestinal subepithelial lesions is safe, but has a moderate diagnostic ability (59.9%) regardless of techniques of FNA/FNB/Tru-Cut needle biopsy or the needle diameter used for puncture. 57 Conversely, a successive meta-analysis reveals that sampling ability of FNA (80.6%) is significantly lower to that of FNB (94.9%), but increase with the help of rapid on-site evaluation.…”

Section: Eus-guided Fine-needle Aspiration/biopsymentioning

confidence: 99%

Advancements in the Diagnosis of Gastric Subepithelial Tumors

2022

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A diagnosis of subepithelial tumors (SETs) is sometimes difficult due to the existence of overlying mucosa on the lesions, which hampers optical diagnosis by conventional endoscopy and tissue sampling with standard biopsy forceps. Imaging modalities, by using computed tomography and endoscopic ultrasonography (EUS) are mandatory to noninvasively collect the target's information and to opt candidates for further evaluation. Particularly, EUS is an indispensable diagnostic modality for assessing the lesions precisely and evaluating the possibility of malignancy. The diagnostic ability of EUS appears increased by the combined use of contrast-enhancement or elastography. Histology is the gold standard for obtaining the final diagnosis. Tissue sampling requires special techniques to break the mucosal barrier. Although EUS-guided fine-needle aspiration (EUS-FNA) is commonly applied, mucosal cutting biopsy and mucosal incision-assisted biopsy are comparable methods to definitively obtain tissues from the exposed surface of lesions and seem more useful than EUS-FNA for small SETs. Recent advancements in artificial intelligence (AI) have a potential to drastically change the diagnostic strategy for SETs. Development and establishment of noninvasive methods including AI-assisted diagnosis are expected to provide an alternative to invasive, histological diagnosis.

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Eus-Fna With 19 or 22 Gauges Needles for Gastric Subepithelial Lesions of the Muscle Layer

Cited by 10 publications

References 25 publications

The Role of Conventional Echoendoscopy (Eus) in Therapeutic Decisions in Patients With Neuroendocrine Gastrointestinal Tumors

The Role of Conventional Echoendoscopy (Eus) in Therapeutic Decisions in Patients With Neuroendocrine Gastrointestinal Tumors

Franseen Needles May Be Promising for Improving the Sampling Adequacy of EUS-FNA for Subepithelial Lesions

Advancements in the Diagnosis of Gastric Subepithelial Tumors

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