Safety and efficacy of endoscopic ultrasound‐guided fine needle aspiration for pancreatic masses: A prospective multicenter study

Senju

et al. 2020

Preprint

Self Cite

Background Combining upper and lower gastrointestinal tract (GI) approaches allows expansion of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) indications for pelvic lesions. The upper GI approach has been used for pelvic lesions around the level of the aortoiliac bifurcation in our institution. The aim of this study is to evaluate the feasibility and safety of EUS-FNA for pelvic lesions via the upper and lower GI approaches. Methods All consecutive patients who underwent EUS-FNA for the pelvic lesion between January 2008 and December 2018 were retrospectively analyzed. Pelvic lesions were defined as lesions located around and below the aortoiliac bifurcation level. The primary outcome was technical success rate, and the secondary outcomes were the diagnostic capability of EUS-FNA for malignancy and the safety. Results EUS-FNA for pelvic lesions was performed in 49 patients—upper and lower GI approaches were used in 28 and 21 patients, respectively. The technical success rates were 91.8% (45/49) in all patients—89.3% (25/28) and 95.2% (20/21) with the upper and lower GI approaches, respectively. Among patients who achieved technical success, the diagnostic accuracy for malignancy was 97.8% (44/45) in all patients—100% (25/25) and 95.0% (19/20) with the upper and lower GI approaches, respectively. One (2.0%) patient developed an adverse event of sigmoid colon perforation. Conclusions EUS-FNA for pelvic lesions via the upper and lower GI approaches was a safe, feasible, and effective method, although careful endoscopic manipulation is reuqired to avoid perforation, especially with the lower GI approach. Further large-scale, well-designed studies are needed to validate our findings.

Section: Technical Performancementioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound-guided fine-needle aspiration of pelvic lesions via the upper and lower gastrointestinal tract approaches

Senju

et al. 2020

Preprint

Self Cite

“…Endoscopic ultrasound-guided ne-needle aspiration (EUS-FNA) has been a standard technique to obtain pathological specimens from lesions around the upper gastrointestinal tract (GI) [1], such as pancreatic tumors [2,3], upper abdominal lymph nodes [4,5], mediastinal masses [6], or upper gastrointestinal submucosal tumors [7,8]. However, the feasibility and safety of EUS-FNA for pelvic lesions have not been well studied, although EUS-FNA for pelvic lesions via the lower GI approach was reported in several studies, including one systematic review and meta-analysis [9][10][11], in which target lesions were limited around the rectal or perirectal area.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound-guided fine-needle aspiration of pelvic lesions via the upper and lower gastrointestinal tract approaches

Senju

et al. 2020

Preprint

Self Cite

Background: Combining upper and lower gastrointestinal tract (GI) approaches allows expansion of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) indications for pelvic lesions. The upper GI approach has been used for pelvic lesions around the level of the aortoiliac bifurcation in our institution. The aim of this study is to evaluate the feasibility and safety of EUS-FNA for pelvic lesions via the upper and lower GI approaches. Methods: All consecutive patients who underwent EUS-FNA for the pelvic lesion between January 2008 and December 2018 were retrospectively analyzed. Pelvic lesions were defined as lesions located around and below the aortoiliac bifurcation level. The primary outcome was technical success rate, and the secondary outcomes were the diagnostic capability of EUS-FNA for malignancy and the safety.Results: EUS-FNA for pelvic lesions was performed in 49 patients: upper and lower GI approaches were used in 28 and 21 patients, respectively. The technical success rates were 91.8% (45/49) in all patients: 89.3% (25/28) and 95.2% (20/21) with the upper and lower GI approaches, respectively. Among patients who achieved technical success, the diagnostic accuracy for malignancy was 97.8% (44/45) in all patients:100% (25/25) and 95.0% (19/20) with the upper and lower GI approaches, respectively. One (2.0%) patient developed an adverse event of sigmoid colon perforation.Conclusions: EUS-FNA for pelvic lesions via the upper and lower GI approaches was a safe, feasible, and effective method, although careful endoscopic manipulation is required to avoid perforation, especially with the lower GI approach. Further large-scale, well-designed studies are needed to validate our findings.

“…EUS-FNA has been widely used as a safe, precise, and less invasive procedure for obtaining pathological materials from pancreatic lesions. [8][9][10][11][12] Because of these features, EUS and EUS-FNA are regarded as important tools for differentiating mucinous neoplastic cysts, such as IPMN and MCN, from other cysts and for diagnosing the malignant transformation of these cysts, even with drawbacks of EUS, such as operator-dependent procedure and relatively invasive nature in comparison with cross-sectional studies. 13 Furthermore, there are some discrepancies in the recommended application of EUS and EUS-FNA between the guidelines.…”

Section: Introductionmentioning

confidence: 99%

Utility of endoscopic ultrasound and endoscopic ultrasound‐guided fine‐needle aspiration for the diagnosis and management of pancreatic cystic lesions: Differences between the guidelines

Uemura

et al. 2019

Digestive Endoscopy

Self Cite

Recent advances and frequent use of cross‐sectional imaging studies have increased opportunities for incidental diagnoses of pancreatic cystic lesions (PCL). In the management of PCL, distinguishing between mucinous versus non‐mucinous and malignant versus benign cysts is important to diagnose pancreatic cancer in its early stage. For this reason, there have been several guidelines to manage PCL. Endoscopic ultrasound (EUS) and EUS‐guided fine‐needle aspiration (FNA) play important roles in the guidelines, although there are some differences in their roles. In this review, we aimed to evaluate the current status of EUS and EUS‐FNA in the management of PCL and the status of these procedures in the guidelines.