Forward-viewing versus oblique-viewing echoendoscopes in the diagnosis of upper GI subepithelial lesions with EUS-guided FNA: a prospective, randomized, crossover study

Background and study aims Endoscopic ultrasound-guided fine needle aspiration (FNA) for gastrointestinal subepithelial lesions (SELs) has limited diagnostic accuracy due to technical problems and small lesion size. We previously reported a novel submucosal tunneling biopsy (STB) technique for sampling SELs. This study aimed to evaluate the diagnostic ability and safety of STB compared to that of FNA for SELs. Patients and methods The study was a non-randomized, prospective comparative study with crossover design in patients with endoluminal gastric SELs. Forty-three patients, including 29 cases with lesions < 2 cm were enrolled. A crossover design with 2 intervention stages (Group A: FNA followed by STB for 23 SELs, Group B: STB followed by FNA for 20 SELs) was implemented. The primary outcome was the diagnostic yield (DY). Secondary outcomes were technical success rate, procedure time, complication rate, and sample quality. Results The DY of STB was significantly higher than that of FNA (100 % vs. 34.8 %; P < 0.0001) in group A, including 100 % in overall STB. The technical success rate of STB was significantly higher than that of FNA (100 % vs. 56.5 %; P = 0.0006), whereas the median procedure time of STB was significantly longer than that of FNA (37 minutes vs. 18 minutes; P < 0.0001). The median specimen area of STB samples was markedly larger than that of FNA samples (5.54 mm2 vs. 0.69 mm2; P < 0.001). No complications occurred in either method. Conclusions STB had significantly superior diagnostic ability and a more adequate sample quality than FNA for endoluminal gastric SELs, indicating the suitability of STB for small SELs. Clinical trial registration: UMIN 000006754

show abstract

“…FNA was performed as described 19 . Briefly, after advancing the needle into the lesion under EUS visualization, the stylet was removed.…”

Section: Methodsmentioning

confidence: 99%

Comparison of submucosal tunneling biopsy versus EUS-guided FNA for gastric subepithelial lesions: a prospective study with crossover design

et al. 2017

View full text Add to dashboard Cite

show abstract

“…All six subepithelial lesions less than 2 cm were diagnosed in this study. A small tumor size was thought to be one of the factors related to a nondiagnostic result for EUS-FNA 2 4. Therefore, the EUS-FB technique is thought to be suitable for all gastrointestinal subepithelial lesions including small tumor sizes.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, we reported the usefulness of EUS-FNA using a forward-viewing echoendoscope with regard to sample area 4. However, the mitotic and proliferative assessments using FNA are thought to be difficult.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Endoscopic ultrasound-guided forceps biopsy from upper gastrointestinal subepithelial lesions using a forward-viewing echoendoscope

et al. 2016

Self Cite

View full text Add to dashboard Cite

Background and study aims: Endoscopic tissue acquisition techniques using needle-knife and biopsy forceps allow abundant tissue acquisition from upper gastrointestinal subepithelial lesions; however, these techniques cannot capture real-time intratumor information. The aim of this study was to evaluate the feasibility of endoscopic ultrasound-guided forceps biopsy (EUS-FB) from upper gastrointestinal subepithelial lesions using a forward-viewing echoendoscope. Patients and methods: This study was a prospective case series. After mucosal cuts, several specimens were taken using a hot biopsy forceps under real-time EUS visualization. The incision was closed using hemoclips. Diagnostic yield, rate of diagnosable samples obtained under EUS visualization, procedure time, and adverse events were assessed. Results: Ten patients (median lesion size 16 mm, range 15 – 44 mm) underwent EUS-FB. The overall rate of histological diagnosis by EUS-FB was 100 % (10/10). The rate of diagnosable samples among all cases was 97.6 % (41/42). The median procedure times for EUS-FB and complete closure were 28.5 and 4.5 minutes, respectively. No adverse events occurred. Conclusions: This newly developed EUS-FB is feasible and allowed forceps biopsy from upper gastrointestinal subepithelial lesions.Study registration: UMIN000015364

show abstract

“…Moreover, even though tissue sampling by using the 19-gauge needle was equally successful with both echoendoscopes (FV-LE, 70.7% vs CLA-EE, 58.5%), the time required to perform the procedure with this needle size was significantly shorter when the FV-LE was used (17 minutes vs 25 minutes, P Z .004). 20 The study of Matsuzaki et al 20 appears meaningful for 2 main reasons: (1) it provides further insight into the potential role of the FV-LE in the management of SELs and (2) it gives useful information for the design of future studies. Although the process was not clearly stated in the text, the authors performed a superiority trial, hypothesizing that the diagnostic yield achieved with the FV-LE might be 20% higher than that achieved with the CLA-EE (ie, 90% vs 70%, respectively), and a sample size of 40 patients was calculated, considering that the same lesion was sampled with both echoendoscopes.…”

mentioning

confidence: 99%

Moving EUS forward-viewing: ready for prime time?

Fuccio

Attili

Larghi

2015

Gastrointestinal Endoscopy

View full text Add to dashboard Cite

Forward-viewing versus oblique-viewing echoendoscopes in the diagnosis of upper GI subepithelial lesions with EUS-guided FNA: a prospective, randomized, crossover study

Cited by 33 publications

References 56 publications

Comparison of submucosal tunneling biopsy versus EUS-guided FNA for gastric subepithelial lesions: a prospective study with crossover design

Comparison of submucosal tunneling biopsy versus EUS-guided FNA for gastric subepithelial lesions: a prospective study with crossover design

Endoscopic ultrasound-guided forceps biopsy from upper gastrointestinal subepithelial lesions using a forward-viewing echoendoscope

Moving EUS forward-viewing: ready for prime time?

Contact Info

Product

Resources

About