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- Original Article Utility of forward-view endoscopic ultrasound in fine-needle aspiration in patients with a surgically altered upper gastrointestinal anatomy
-
Asmaa Bakr1,3
, Kazuo Hara1, Moaz Elshair1,2, Shin Haba1, Takamichi Kuwahara1, Nozomi Okuno1, Daiki Fumihara1, Takafumi Yanaidani1, Samy Zaky3, Hanaa Omar3 -
Clinical Endoscopy 2023;56(3):367-374.
DOI: https://doi.org/10.5946/ce.2021.238
Published online: January 5, 2023
1Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
2Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, Nasr City, Egypt
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- Correspondence: Kazuo Hara Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan E-mail: khara@aichi-cc.jp
• Received: September 17, 2021 • Revised: March 25, 2022 • Accepted: March 26, 2022
Copyright © 2023 Korean Society of Gastrointestinal Endoscopy
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
-
Background/Aims
- Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) using oblique-view EUS in patients with a surgically altered anatomy (SAA) of the upper gastrointestinal tract is limited because of difficult scope insertion due to the disturbed anatomy. This study aimed to investigate the efficiency of forward-view (FV)-EUS in performing FNA in patients with a SAA.
-
Methods
- We retrospectively investigated 32 patients with a SAA of the upper gastrointestinal tract who visited Aichi Cancer Center Hospital in Nagoya, Japan, between January 2014 and December 2020. We performed-upper gastrointestinal EUS-FNA using FV-EUS combined with fluoroscopic imaging to confirm tumor recurrence or to make a decision before chemotherapy or after a failure of diagnosis by radiology.
-
Results
- We successfully performed EUS-FNA in all studied patients (100% technical success), with the specificity, sensitivity, and accuracy of 100%, 87.5%, and 87.8%, respectively, with no complications.
-
Conclusions
- EUS-FNA using FV-EUS combined with fluoroscopic imaging is an effective and safe technique for tissue acquisition in patients with a SAA.
Graphic abstract
INTRODUCTION
METHODS
RESULTS
DISCUSSION
Conflicts of Interest
The authors have no potential conflicts of interest.
Funding
None.
Author Contributions
Conceptualization: KH, SH, TK, NO, SZ, HO; Data curation: NO, DF, TY; Investigation: AB, MEl; Methodology: AB, KH, ME; Project administration: KH, NO; Software: AB, ME; Supervision: AB, KH, ME, SH, TK, NO; Writing–original draft: AB, ME; Writing–review & editing: all authors.
Fig. 1.(A) Oblique-view endoscopic ultrasound scope with maximum angulation in retroflexion with the use of an elevator. It is usually difficult to advance the needle in this position. (B) Forward-view endoscopic ultrasound scope in full retroflexion with no elevator. Note that this position facilitates smooth needle advancement compared with oblique-view endoscopic ultrasound. Courtesy of Prof. Pietro Fusaroli at the University of Bologna, Italy. Endosc Ultrasound 2013;2:64–70.9
Fig. 2.(A) Forward-view endoscopic ultrasound image showing lymph node swelling around the hepatic hilum and the needle inserted inside the lesion for fine-needle aspiration. (B) Forward-view endoscopic ultrasound image showing lymph node swelling around the portal vein and the needle inserted inside the lesion for fine-needle aspiration.
Fig. 3.Tip of the forward-view endoscopic ultrasound scope under fluoroscopy, passing through the afferent loop toward the lesion.
Table 1.Demographic and surgical features of the studied cases
Table 2.Details of the EUS-FNA procedure
Table 3.Adverse events of EUS-FNA (n=32)
| Adverse event | % |
|---|---|
| Perforation | 0 |
| Bleeding | 0 |
| Mild abdominal pain and discomfort | 0 |
| Aspiration pneumonia | 0 |
| Anesthesia-related | 0 |
Table 4.Unsuccessful cases by FV-EUS
- 1. Vilmann P, Jacobsen GK, Henriksen FW, et al. Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease. Gastrointest Endosc 1992;38:172–173.ArticlePubMed
- 2. Yamao K, Sawaki A, Mizuno N, et al. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB): past, present, and future. J Gastroenterol 2005;40:1013–1023.ArticlePubMedPDF
- 3. Fusaroli P, Kypraios D, Caletti G, et al. Pancreatico-biliary endoscopic ultrasound: a systematic review of the levels of evidence, performance and outcomes. World J Gastroenterol 2012;18:4243–4256.ArticlePubMedPMC
- 4. Mortensen MB, Pless T, Durup J, et al. Clinical impact of endoscopic ultrasound-guided fine needle aspiration biopsy in patients with upper gastrointestinal tract malignancies. A prospective study. Endoscopy 2001;33:478–483.ArticlePubMed
- 5. Katanuma A, Hayashi T, Kin T, et al. Interventional endoscopic ultrasonography in patients with surgically altered anatomy: techniques and literature review. Dig Endosc 2020;32:263–274.ArticlePubMedPDF
- 6. Hara K, Okuno N, Haba S, et al. How to perform EUS-guided hepaticogastrostomy easier and safer. J Hepatobiliary Pancreat Sci 2020;27:563–564.ArticlePubMedPDF
- 7. Elshair M, Hara K, Kuwahara T, et al. Utility of stent-in-stent technique in management of post-pancreatitis splenic abscess using forward-viewing echoendoscope. J Hepatobiliary Pancreat Sci 2021;28:e40–e41.ArticlePubMedPDF
- 8. Imaizumi H, Irisawa A. Preliminary experience of a prototype forward-viewing curved linear array echoendoscope in a training phantom model. Dig Endosc 2010;22(Suppl 1):S123–S127.ArticlePubMed
- 9. Fusaroli P, Ceroni L, Caletti G, et al. Forward-view endoscopic ultrasound: a systematic review of diagnostic and therapeutic applications. Endosc Ultrasound 2013;2:64–70.ArticlePubMedPMC
- 10. Haba S, Yamao K, Bhatia V, et al. Diagnostic ability and factors affecting accuracy of endoscopic ultrasound-guided fine needle aspiration for pancreatic solid lesions: Japanese large single center experience. J Gastroenterol 2013;48:973–981.ArticlePubMedPDF
- 11. Unno J, Kanno A, Masamune A, et al. The usefulness of endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of pancreatic neuroendocrine tumors based on the World Health Organization classification. Scand J Gastroenterol 2014;49:1367–1374.ArticlePubMed
- 12. Polkowski M, Jenssen C, Kaye P, et al. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline - March 2017. Endoscopy 2017;49:989–1006.ArticlePubMed
- 13. Stelow EB, Debol SM, Stanley MW, et al. Sampling of the adrenal glands by endoscopic ultrasound-guided fine-needle aspiration. Diagn Cytopathol 2005;33:26–30.ArticlePubMed
- 14. Larghi A, Ibrahim M, Fuccio L, et al. Forward-viewing echoendoscope versus standard echoendoscope for endoscopic ultrasound-guided tissue acquisition of solid lesions: a randomized, multicenter study. Endoscopy 2019;51:444–451.ArticlePubMed
- 15. Wilson JA, Hoffman B, Hawes RH, et al. EUS in patients with surgically altered upper GI anatomy. Gastrointest Endosc 2010;72:947–953.ArticlePubMed
- 16. Tanaka K, Hayashi T, Utsunomiya R, et al. Endoscopic ultrasound-guided fine needle aspiration for diagnosing pancreatic mass in patients with surgically altered upper gastrointestinal anatomy. Dig Endosc 2020;32:967–973.ArticlePubMedPDF
- 17. Fusaroli P, Serrani M, Lisotti A, et al. Performance of the forward-view echoendoscope for pancreaticobiliary examination in patients with status post-upper gastrointestinal surgery. Endosc Ultrasound 2015;4:336–341.ArticlePubMedPMC
- 18. Thinrungroj N, Hara K, Mizuno N, et al. Utility of forward-view echoendoscopy for transcolonic fine-needle aspiration of extracolonic lesions: an institutional experience. Clin Endosc 2020;53:60–64.ArticlePubMedPMCPDF
- 19. Brozzi L, Petrone MC, Poley JW, et al. Outcomes of biliopancreatic EUS in patients with surgically altered upper gastrointestinal anatomy: a multicenter study. Endosc Int Open 2020;8:E869–E876.ArticlePubMedPMC
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Citations
Citations to this article as recorded by 
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Utility of forward-view endoscopic ultrasound in fine-needle aspiration in patients with a surgically altered upper gastrointestinal anatomy
Fig. 1. (A) Oblique-view endoscopic ultrasound scope with maximum angulation in retroflexion with the use of an elevator. It is usually difficult to advance the needle in this position. (B) Forward-view endoscopic ultrasound scope in full retroflexion with no elevator. Note that this position facilitates smooth needle advancement compared with oblique-view endoscopic ultrasound. Courtesy of Prof. Pietro Fusaroli at the University of Bologna, Italy. Endosc Ultrasound 2013;2:64–70.9
Fig. 2. (A) Forward-view endoscopic ultrasound image showing lymph node swelling around the hepatic hilum and the needle inserted inside the lesion for fine-needle aspiration. (B) Forward-view endoscopic ultrasound image showing lymph node swelling around the portal vein and the needle inserted inside the lesion for fine-needle aspiration.
Fig. 3. Tip of the forward-view endoscopic ultrasound scope under fluoroscopy, passing through the afferent loop toward the lesion.
Fig. 4. Picture of the detachable cap (endoscopic distal attachment cap; Olympus Medical Systems).
Graphical abstract
Fig. 1.
Fig. 2.
Fig. 3.
Fig. 4.
Graphical abstract
Utility of forward-view endoscopic ultrasound in fine-needle aspiration in patients with a surgically altered upper gastrointestinal anatomy
| Patient data | Value |
|---|---|
| Sex | |
| Female | 21 (65.6) |
| Male | 11 (34.3) |
| Age (yr) | 68.5 (46–82) |
| Type of surgical operation | |
| Pancreatoduodenectomy | 26 (81.2) |
| Total pancreatectomy | 3 (9.3) |
| Left HPD | 1 (3.1) |
| Total gastrectomy Roux-en-Y | 1 (3.1) |
| Esophagectomy and total gastrectomy | 1 (3.1) |
| Indication for surgery | |
| Pancreatic cancer | 19 (59.3) |
| Cholangiocarcinoma | 8 (25.0) |
| Intraductal papillary mucinous cancer | 1 (3.1) |
| Duodenal cancer | 1 (3.1) |
| Ampulla of Vater cancer | 1 (3.1) |
| Gastric cancer | 1 (3.1) |
| Gastric and esophageal cancer | 1 (3.1) |
| Lesion assessment | Value |
|---|---|
| Lesion-diameters (mm) | 15.7 (8–23) |
| Target lesion for FNA | |
| Peritoneal dissemination | 14 (43.7) |
| Lymph node swelling | 9 (28.1) |
| Anastomotic mass | 4 (12.5) |
| Liver metastasis | 2 (6.2) |
| Mass around the celiac | 1 (3.1) |
| Mass around superior mesenteric artery | 1 (3.1) |
| Pelvic mass | 1 (3.1) |
| Pass insertion | |
| Trans-jejunum | 27 (84.3) |
| Stomach | 3 (9.3) |
| Trans-jejunum and trans-stomach | 1 (3.1) |
| Y legged | 1 (3.1) |
| Site of puncture | |
| Around superior mesenteric artery | 7 (21.8) |
| Para aortic | 4 (12.5) |
| Bile duct jejunal anastomosis | 4 (12.5) |
| Around the portal vein | 4 (12.5) |
| Trans-jejunum | 2 (6.2) |
| Wisteria jejunal anastomosis | 1 (3.1) |
| Near the right renal artery | 1 (3.1) |
| Liver segment 5 | 1 (3.1) |
| Right loop of the liver | 1 (3.1) |
| In relation to superior mesenteric vein | 1 (3.1) |
| Y legged anastomosis | 1 (3.1) |
| In relation to the hepatic hilum | 1 (3.1) |
| Lymph node 12 | 1 (3.1) |
| Head of the pancreas | 1 (3.1) |
| Celiac surroundings | 1 (3.1) |
| Abdominal disseminating nodules | 1 (3.1) |
| EUS procedure time (min) | 51 (18–135) |
| Adverse event | % |
|---|---|
| Perforation | 0 |
| Bleeding | 0 |
| Mild abdominal pain and discomfort | 0 |
| Aspiration pneumonia | 0 |
| Anesthesia-related | 0 |
| Case | EUS-FNA (cytology) | EUS-FNA (cell block) | Final diagnosis |
|---|---|---|---|
| 1 | Insufficient specimen | Insufficient specimen | No malignancy |
| 2 | Insufficient specimen | Insufficient specimen | No malignancy |
| 3 | Insufficient specimen | Insufficient specimen | Suspected recurrence after surgery for bile duct cancer |
| 4 | Insufficient specimen | Insufficient specimen | No malignancy |
Table 1. Demographic and surgical features of the studied cases
Values are presented number (%) or mean (range). PD, pancreatoduodenectomy; HPD, PD and left lobe hepatectomy.
Table 2. Details of the EUS-FNA procedure
Values are presented median (range) or number (%). EUS-FNA, endoscopic ultrasound-guided fine-needle aspiration.
Table 3. Adverse events of EUS-FNA (n=32)
EUS-FNA, endoscopic ultrasound-guided fine-needle aspiration.
Table 4. Unsuccessful cases by FV-EUS
FV-EUS, forward-view endoscopic ultrasound; EUS-FNA, EUS-guided fine-needle aspiration.
