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Extraluminal bleeding after endoscopic ultrasound (EUS)- guided fine-needle aspiration of a gastrointestinal stromal tumor (GIST). (a) Endoscopic view of a gastric GIST; (b) EUS Doppler imaging reveals intralesional vessels; (c) New hyperechoic area signaling blood can be seen lying in proximity to the needle tract; (d) Increasing size of the hyperechoic area, indicating continued bleeding, within the GIST
Source publication
Endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) is often the preferred technique for tissue acquisition in the diagnosis of suspected intrathoracic and intraabdominal pathology. Although EUS FNA is a safe and accurate procedure, it has been associated with a low risk of adverse events. The unique properties of the echoendoscope and...
Similar publications
Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of the liver is a safe procedure in the diagnosis and staging of hepatobiliary malignancies with a minimal major complication rate. EUS-FNA is useful for liver lesions poorly accessible to other imaging modalities of the liver. EUS-guided FNA of biliary neoplasia and malignant biliary...
Citations
... It is worth mentioning that there are no specific immune-histochemical markers for distinguishing DCCA from PDCA (4). Additionally, although the ultrasoundguided invasive tissue biopsy may provide pathological confirmation, the risk of tumor dissemination, hemorrhage, organ injuries, or inflammation has made this medical procedure more technically challenging and less widely applicable (22)(23)(24). These factors all make the precise diagnosis of DCCA and PDCA more confusing. ...
Objective
To evaluate the consistencies and inconsistencies between distal cholangiocarcinoma (DCCA) and pancreatic ductal adenocarcinoma (PDCA) regarding their biological features and long-term prognosis.
Methods
PubMed, the Cochrane Library, and EMBASE were searched to find comparative studies between DCCA and PDCA. RevMan5.3 and Stata 13.0 software were used for the statistical analyses.
Results
Eleven studies with 4,698 patients with DCCA and 100,629 patients with PDCA were identified. Pooled results indicated that patients with DCCA had a significantly higher rate of preoperative jaundice (p = 0.0003). Lymphatic metastasis (p < 0.00001), vascular invasion (p < 0.0001), and peri-neural invasion (p = 0.005) were more frequently detected in patients with PDCA. After curative pancreaticoduodenectomy (PD), a significantly higher R0 rate (p < 0.0001) and significantly smaller tumor size (p < 0.00001) were detected in patients with DCCA. Patients with DCCA had a more favorable overall survival (OS) (p < 0.00001) and disease-free survival (DFS) (p = 0.005) than patients with PDCA. However, postoperative morbidities (p = 0.02), especially postoperative pancreatic fistula (POPF) (p < 0.00001), more frequently occurred in DCCA.
Conclusion
Patients with DCCA had more favorable tumor pathological features and long-term prognosis than patients with PDCA. An early diagnosis more frequently occurred in patients with DCCA. However, postoperative complications, especially POPF, were more frequently observed in patients with DCCA.
... With the increasing role of neoadjuvant therapy in the treatment of resectable and borderline resectable pancreatic carcinomas, EUS-FNA plays a crucial role in the diagnostic workup in these cases [34]. Despite EUS-FNA sensitivity and specificity reaching 85-89% and 96-99%, the actual guidelines for the management of primary radically operable pancreatic cancer (European Society of Gastrointestinal Endoscopy guidelines, German guidelines-S3) consider EUS-FNA as a non-mandatory method in the management of these cases [1,35,36]. Seeding is considered an overlooked and underestimated problem with clinical impact for the selected group of patients [37]. Current clinical practice is still not following recommendations and guidelines, and most resectable PDAC cases are referred to surgery following EUS-FNA. ...
Background:
Endosonography-guided fine needle aspiration biopsy (EUS-FNA)-associated metachronous gastric seeding metastases (GSM) of pancreatic ductal adenocarcinoma (PDAC) represent a serious condition with insufficient evidence.
Methods:
Retrospective analysis of PDAC resections with a curative-intent, proven pathological diagnosis of PDAC, preoperative EUS-FNA and post-resection follow-up of at least 60 months. The systematic literature search of published data was used for the GSM growth evaluation using Pearson correlation and the linear regression analyses.
Results:
The inclusion criteria met 59/134 cases, 16 (27%) had retained needle tract (15 following distal pancreatectomy, 1 following pylorus-sparing head resection). In total, 3/16 cases (19%) developed identical solitary GSM (10-26th month following primary surgery) and were radically resected. A total of 30 published cases of PDAC GSM following EUS-FNA were identified. Lesion was resected in 20 distal pancreatectomy cases with complete information in 14 cases. A correlation between the metastasis size and time (r = 0.612) was proven. The regression coefficient b = 0.72 expresses the growth of 0.72 mm per month.
Conclusions:
The GSM represent a preventable and curable condition. A remarkably high number of GSM following EUS-FNA was identified, leading to follow-up recommendation of EUS-FNA sampled patients. Multimodal management (gastric resection, adjuvant chemotherapy) may prolong survival.
... However, needle track seeding, although uncommon, is a serious adverse event that may impair patient's outcome [3]. Considering the associated risk, EUS-guided fine-needle biopsy should be carried out only when the results obtained are useful for therapeutic decision-making [4], and the needle tract line should be placed within the surgical resection margins. ...
... The puncture of such a duct may lead to extravasation of pancreatic juice. 91 (2) Infectious complications The incidence of bacteremia or even infection after EUS-guided tissue acquisition is very low, usually insignificant, and similar to that of diagnostic endoscopy including EUS without tissue acquisition. 92 Furthermore, patients who develop bacteremia after EUS-guided tissue acquisition rarely manifest with a clinical infectious illness. ...
Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy (KSGE) appointed a task force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in eight categories intended to help physicians make evidence-based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice.
... [3] Bowel preparation quality of the rectosigmoid colon should be noted in lower EUS procedures, as this can impact visualization, the technical ease of the procedure, and the potential increased risk of infection of EUS-FNA in areas of poor bowel preparation. [23,24] Reporting of bowel preparation quality should be done utilizing a validated scoring system such as the Boston Bowel Preparation Scale or the Ottawa Bowel Preparation Scale. [25] The type of bowel preparation and regiment used should be included in all lower EUS procedure reports. ...
Background and objectives:
Quality indicators for the performance of EUS have been developed to monitor and improve service value and patient outcomes. To support the incorporation of these indicators and standardize EUS documentation, we propose standard EUS reporting elements for endosonographers and endoscopy units.
Methods:
A comprehensive literature search and review was performed to identify EUS quality indicators and key components of high-quality standardized EUS reporting. Guidance statements regarding standard EUS reporting elements were developed and reviewed at the Forum for Canadian Endoscopic Ultrasound (FOCUS) 2019 Annual Meeting.
Results:
EUS reporting elements can be divided into preprocedural, intraprocedural, and postprocedural items. Preprocedural components include the type, indication, and urgency of the procedure and patient clinical information and consent. Intraprocedural components include the adequacy and extent of examination, relevant landmarks, lesion characteristics, sampling method, specimen quality, and intraprocedural adverse events. Postprocedural components include a summary and synthesis of relevant findings as well as recommended management and follow-up.
Conclusions:
Standardizing reporting elements may help improve the care of patients undergoing EUS procedures. Our review provides a practical guide and compilation of recommended reporting elements to ensure ongoing best practices and quality improvement in EUS.
... Histological confirmation is required for ultimate diagnosis in non-resectable patients prior to administration of a palliative chemotherapy regimen. The different modalities of invasive tissue sampling can be technically challenging and associated with severe risks, including tumor seeding along the biopsy tract, hemorrhage, organ perforation or inflammation [8,12,13]. Moreover, because of the dense desmoplastic reaction especially in PDAC, a large part of the tumor mass consists of stromal cells, giving rise to false negative results and eventually necessitating re-biopsies, which further increase the risk of complications and may delay the therapy substantially [12]. ...
... The different modalities of invasive tissue sampling can be technically challenging and associated with severe risks, including tumor seeding along the biopsy tract, hemorrhage, organ perforation or inflammation [8,12,13]. Moreover, because of the dense desmoplastic reaction especially in PDAC, a large part of the tumor mass consists of stromal cells, giving rise to false negative results and eventually necessitating re-biopsies, which further increase the risk of complications and may delay the therapy substantially [12]. ...
Simple Summary
To elucidate and compare the value of plasma and bile as liquid biopsy source, cfDNA from 80 patients with pancreatobiliary cancers or non-malignant biliary obstructions was subjected to panel-based next generation sequencing (NGS). Results showed high correspondence in mutational profiles of bile-derived cfDNA and matched tissue samples, and the method proved superior to traditional plasma-based liquid biopsy techniques and with higher sensitivity than routine biomarkers such as CA19-9.
Abstract
Currently available serum biomarkers for pancreatobiliary cancers lack sensitivity and specificity and ultimate diagnosis still requires invasive procedures for histological confirmation. The detection of tumor-specific genetic aberrations with utilization of cell free DNA (cfDNA) is a less invasive approach than traditional tissue biopsies; however, it has not been implemented into clinical routine. In this study, we investigated bile as a liquid biopsy source in pancreatobiliary cancers and compared its potential as cell-free DNA source to plasma. Blood (n = 37) and bile (n = 21) samples were collected from patients affected by pancreatic ductal adenocarcinoma (PDAC) and extrahepatic cholangiocarcinoma (CCA) or with non-malignant biliary obstructions (blood n = 16; bile n = 21). Panel-based next generation sequencing (NGS) and digital droplet PCR (ddPCR) were applied for tumor mutation profiling. NGS results from matched tumor tissues (n = 29) served as comparison. Sequencing of cfDNA from bile resulted in detection of 96.2% of the pathogenic tumor mutations found in matched tissue samples. On the other hand, only 31.6% of pathogenic tumor mutations found in tissue could be detected in plasma. In a direct comparison, only half of the mutations detected in bile cfDNA were concordantly detected in plasma from the same patients. Panel NGS and ddPCR displayed comparable sensitivity. In conclusion, bile is a suitable source of cfDNA for the diagnosis of pancreatobiliary cancer and performs more reliably than plasma. Although primary diagnosis still requires histologic confirmation, bile-derived cfDNA could offer an alternative if tissue sampling is not feasible and might allow less invasive disease monitoring.
... In addition, research shows that changes in the levels of CA19-9 are frequently more than 6 mo earlier than radiological recurrence in patients with pancreatic cancer [64] . In addition, PET-CT represents a more sensitive approach compared with the traditional imaging methods (CT and magnetic resonance imaging [MRI]), and it is also used for the early detection of tumor recurrence after pancreatic cancer surgery [65,66] . Six (100%) cases receiving PET showed that the seeding tumors increased the uptake of fluorodeoxyglucose. ...
Endoscopic ultrasound-guided minimally invasive tissue acquisition can be performed by two approaches as follows: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB). These have been evolved into leading approaches and widely used for the histological diagnosis of tumors in the gastrointestinal tract and adjacent organs. However, the role of EUS-FNA and EUS-FNB in disease diagnosis and evaluation remains controversial. Although the incidence of surgery-associated complications remains low, the consequences of needle tract seeding can be serious or even life-threatening. Recently, increasing case reports of needle tract seeding are emerging, especially caused by EUS-FNA. This complication needs serious consideration. In the present work, we integrated these case reports and the related literature, and summarized the relevant cases and technical characteristics of needle tract seeding caused by EUS-FNA and EUS-FNB. Collectively, our findings provided valuable insights into the prevention and reduction of such serious complication. © The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
... Our overall AE incidence was 3.4%, which is greater than what some previous retrospective studies have reported. Adverse event risk estimates associated with EUS-FNA range between 1% and 4% (12,(14)(15)(16). Sources of AE risk variation between studies include how the adverse outcomes are defined, the study design, the data quality, the patient population being studied, and the expertise of the endoscopist(s) performing the EUS procedures. ...
Background:
The quality of endoscopic ultrasound (EUS) involving advanced endoscopy trainees (AETs) is not well understood. In this study, we aimed to examine adverse events (AE) risk and diagnostic yield of EUS procedures involving AETs.
Methods:
We conducted a retrospective single-centre review from September 2009 to August 2015. Clinical, procedural, cytological, and hospital visit data within 30 days of the EUS procedure was collected. Primary outcomes were occurrence of an AE and a diagnostic specimen on cytopathology. Each AE was classified as "definitely related," "possibly related," or "not related" to the EUS procedure based on a previously defined consensus approach. Advanced endoscopy trainee involvement was established through the operative report.
Results:
Our study included 1657 EUS procedures, of which 27% (451 of 1657) involved AETs. Endoscopic ultrasound was most commonly performed to evaluate pancreatic pathology (46% of cases). Overall AE incidence was 3.4%; it was 4.9% when an AET was involved and 2.8% when the EUS was performed without an AET (P = 0.04). The risk of an AE when AETs were involved was greatest in the first three months of training (7.9% versus 2.7%, P = 0.04). Multivariate analysis limited to the first three months of training demonstrated AET involvement to be associated with an increased AE risk after adjusting for patient and procedural factors (adjusted OR 3.2; 95% CI, 1.1-8.7; P = 0.03). The overall diagnostic yield was 76%. This was not compromised by AET involvement for any quartile of training.
Conclusions:
We observed an increased risk of EUS-related AEs when procedures involved AETs during the first three months of training.
... La tasa de complicaciones con respecto a la hemorragia es similar a la observada por endoscopia estándar. A pesar del uso de Doppler, se reportó hemorragia con una incidencia de 5.2% que coincide con lo reportado por Fuji et al. 34 . ...
Introducción:
El ultrasonido endoscópico (USE) es una herramienta eficaz para la evaluación de trastornos gastrointestinales en adultos, pero su utilidad clínica en niños es limitada. Desafortunadamente, no hay muchos centros donde el USE esté disponible. Asimismo, existen pocos gastroenterólogos que se encuentren capacitados para realizar este procedimiento en paciente pediátricos. Este estudio tiene como objetivo evaluar la viabilidad, seguridad y utilidad clínica del USE en el diagnóstico y tratamiento de trastornos gastrointestinales en niños en un centro de referencia en México.
Objetivo:
Evaluar la aplicabilidad, seguridad e impacto clínico del ultrasonido endoscópico en el manejo de enfermedades gastrointestinales en niños del Centro Médico Nacional 20 de Noviembre.
Método:
Se realizó un análisis retrospectivo de los registros de niños (<18 años) que se sometieron a USE de octubre de 2016 a noviembre de 2019 en el servicio de endoscopia del Centro Médico Nacional 20 de Noviembre - ISSSTE. Se determinaron las indicaciones, la eficacia, la seguridad y el impacto clínico. El impacto clínico se definió como el establecimiento de un nuevo diagnóstico o enfoque terapéutico como resultado de los hallazgos del USE.
Resultados:
se realizaron 21 procedimientos en 19 pacientes (8 niños / 11 niñas) con una mediana de edad 14 años (1.5 - 17 años) siendo el paciente más joven de 17 meses. La enfermedad biliopancreática fue la principal indicación de USE (90,4%). Las otras indicaciones fueron patología rectal y esofágica las cuales representaron un caso cada una. El 61.9% de los casos el USE se realizó con fines de diagnóstico mientras que en el 38.1% restante se requirió terapéutica (8/13) Ocho procedimientos fueron terapéuticos: biopsia con aguja fina guiada por USE (EUS-FNA) se realizó en tres pacientes, drenaje de pseudoquistes pancreáticos (3/8), pancreatografía transgástrica (1/8) y colangiografía transduodenal con drenaje biliar (1/8). Un paciente tuvo hemorragia autolimitada como evento adverso menor. El USE fue clínicamente útil en todos los pacientes.
Conclusión:
El USE es una herramienta segura y útil en pacientes pediátricos, principalmente en aquellos con enfermedades biliopancreáticos.
... [39,40] Tumor seeding and GI perforation has also been rarely reported. [41] The future of EUS-guided tissue acquisition ...
Endoscopic ultrasound-guided fine needle aspiration (EUS FNA) has made pathological diagnosis of pancreatic neoplasms, diseases involving lymph nodes at various mediastinal and abdominal sites, gastrointestinal submucosal lesions, perirectal lesions, adrenal lesions, and mediastinal masses easy. EUS-guided FNA is a multistep procedure that involves assessment of proper clinical indication, correct selection of FNA needles, and adoption of evidence-based techniques for tissue sampling. EUS FNA is done by needles that are available in different sizes, mainly 25, 22, and 19-gauge needle. The need of onsite cytopathologist, dependence on histology/core biopsy occasionally to get a diagnosis, and inability to reliably assess for molecular markers are important limitations of EUS FNA. EUS-guided fine needle biopsy (FNB) that samples the core of tissue is an exciting new development in the field of diagnostic EUS. FNB needles are expensive than FNA needles, and although the initial results are encouraging, more studies with robust evidence proving their superiority beyond any doubt are needed before they can be widely used. © 2019 Wolters Kluwer Medknow Publications. All rights reserved.
