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Original Article
Endoscopic ultrasound-guided plugged liver biopsy using a fine-needle biopsy needle and coils in patients with deranged coagulation parameters: proof of concept study for feasibility and safety from India
Biswa Ranjan Patra, Shubham Gupta, Yash Kallurwar, Chetan Saner, Sidharth Harindranath, Ankita Singh, Arun Vaidya, Michael Kuruthukulangara, Jitendra Yadav, Gaurav Lodha, Souradeep Pal, Akash Shukla
Received June 11, 2025  Accepted September 7, 2025  Published online December 23, 2025  
DOI: https://doi.org/10.5946/ce.2025.188    [Epub ahead of print]
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound (EUS)-guided liver biopsy in patients with coagulopathy remains unexplored mainly because of the lack of effective hemostatic techniques in the event of post-biopsy bleeding. This study evaluated the feasibility and safety of a novel technique, EUS-guided plugged liver biopsy (EUS-PLB), which incorporates coil embolization for tract hemostasis.
Methods
In a pilot study, 20 patients with coagulopathy (platelets 20,000–50,000/μL or international normalized ratio 1.5–2.5) underwent EUS-PLB using a modified heparinized wet suction technique. Hemostasis was achieved via real-time EUS-guided deployment of 1 to 2 coils (35-5-3) into the needle tract. Outcomes included technical and clinical success, sample adequacy, and adverse events.
Results
Coil placement was technically successful in all patients. Persistent needle-tract bleeding occurred in five cases and was effectively controlled. The clinical success rate for preventing significant bleeding (early or delayed) was 100%. Adequate biopsy samples were obtained in 18/20 patients (90%), with a mean total specimen length of 3.34±0.88 cm and median complete portal tracts of 18 (range, 6–25). Histological diagnosis was possible in 95% of cases. One patient experienced a mild adverse event (5%).
Conclusions
This novel EUS-PLB technique with coil embolization may offer a safe and effective biopsy solution for patients with coagulopathy and warrants further investigation.
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Review
Non-invasive colorectal cancer screening: emerging tools and clinical evidence
Hyoung Il Choi, Jae Myung Cha
Received July 28, 2025  Accepted September 12, 2025  Published online December 3, 2025  
DOI: https://doi.org/10.5946/ce.2025.246    [Epub ahead of print]
AbstractAbstract PDFPubReaderePub
The fecal immunochemical test (FIT) is a widely used non-invasive screening method for colorectal cancer (CRC) in many countries, valued for its simplicity, affordability, and reasonable sensitivity. Typically recommended on an annual or biennial basis, the FIT is effective in reducing CRC incidence and mortality by facilitating early detection. Stool DNA tests, including multitarget DNA tests and DNA methylation assays, demonstrate higher sensitivity than FIT for CRC and advanced adenomas, although they have slightly lower specificity and higher cost. These tests are generally performed at longer intervals, such as every 3 years, and are useful alternatives for individuals who are unwilling or unable to undergo a colonoscopy. Emerging non-invasive CRC screening tools, such as liquid biopsy, microRNA, microbiome tests, and urine-based tests, are being developed to improve patient compliance and test convenience. In particular, liquid biopsy offers a minimally invasive option that may be more acceptable to populations hesitant to undergo stool-based tests. Furthermore, the integration of machine learning with metagenomic sequencing data has shown promise in distinguishing patients with CRC from healthy individuals. As CRC screening evolves, these novel approaches may enable the development of more personalized, accessible, and effective screening strategies, ultimately improving adherence and reducing CRC-related mortality.
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Original Articles
The feasibility and safety of trans-colorectal endoscopic ultrasound-guided fine-needle aspiration: a retrospective study of Japan
Takashi Kondo, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Hiroki Koda, Yoshitaro Yamamoto, Minako Urata, Keigo Oshiro, Tomoki Ogata, Ren Kuwabara, Indria Melianti, Yousik Myung, Adwoa Afrakoma Agyei-Nkansah
Clin Endosc 2025;58(6):890-897.   Published online November 27, 2025
DOI: https://doi.org/10.5946/ce.2025.042
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an effective diagnostic technique; however, few studies have evaluated the efficacy of trans-colorectal EUS-FNA. This study assessed the feasibility of trans-colorectal EUS-FNA.
Methods
We retrospectively analyzed 76 consecutive patients who underwent trans-colorectal EUS-FNA for pelvic lesions between January 2013 and September 2023.
Results
A total of 76 pelvic lesions were identified. The median number of EUS-FNA punctures was 3 (1–8). The median lesion size was 18.9 (8.2–100.0) mm. The success rate was 98.7% (75/76), with no reported adverse events. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS-FNA were 94.3% (50/53), 100% (22/22), 100% (50/50), 88.0% (22/25), and 96.0% (72/75), respectively. Malignancy was initially suspected in 65 patients before EUS-FNA; however, 25 patients showed benign results. Of these, three were later reexamined and diagnosed with malignancy, three underwent surgery and were found to have benign pathology, and 19 avoided unnecessary surgery.
Conclusions
Trans-colorectal EUS-FNA is a safe and effective diagnostic procedure.
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A retrospective study on the comparative use of fine-needle biopsy and aspiration for the diagnosis and classification of malignant lymphoma in Japan
Fumitaka Niiya, Akihiro Nakamura, Yasuo Ueda, Takafumi Ogawa, Naoki Tamai, Masataka Yamawaki, Jun Noda, Tetsushi Azami, Yuichi Takano, Masatsugu Nagahama
Clin Endosc 2025;58(5):757-765.   Published online May 27, 2025
DOI: https://doi.org/10.5946/ce.2024.320
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is essential for diagnosing malignant lymphoma (ML). However, the optimal needle type for maximizing the diagnostic yield and tissue quality remains unclear. We compared the diagnostic performance and histological tissue quality between fine-needle biopsy (FNB) and fine-needle aspiration (FNA) needles in EUS-TA for ML.
Methods
This retrospective study included patients who underwent EUS-TA for suspected ML. The diagnostic accuracy, histological sample quality assessed by scoring, and adverse events were compared between the FNB and FNA groups. A subgroup analysis was performed for 22-gauge needles.
Results
FNB demonstrated higher diagnostic accuracy (75%) than FNA (50%) for cytology, with 100% sensitivity for histological diagnosis compared with 78.9% for FNA. The FNB group had significantly higher diagnostic rates for the World Health Organization subclassification of ML (71.4% vs. 31.6%, p=0.037). Additionally, FNB obtained superior histological quality, with 71.4% of samples scoring 5 compared with 41.2% in the FNA group. Adverse events were minimal in both groups.
Conclusions
EUS-FNB showed better diagnostic performance and histological tissue quality than EUS-FNA for ML, particularly in obtaining adequate samples for histological evaluation and subclassification. Therefore, EUS-FNB can be safely performed. Future research with larger sample sizes and genetic testing is warranted.

Citations

Citations to this article as recorded by  
  • Endoscopic Ultrasound as a Diagnostic Tool for the Mediastinum and Thorax
    Sara Nikolic, Lucía Guilabert, Giuseppe Vanella, Catalina Vladut, Giuseppe La Mattina, Giuseppe Infantino, Elio D’Amore, Cecilie Siggaard Knoph, Giacomo Emanuele Maria Rizzo
    Journal of Clinical Medicine.2025; 14(14): 4836.     CrossRef
  • Refining the diagnostic strategy for malignant lymphoma: advantages of endoscopic ultrasound-guided fine-needle biopsy over aspiration
    Kyong Joo Lee, Se Woo Park
    Clinical Endoscopy.2025; 58(5): 701.     CrossRef
  • 2,705 View
  • 165 Download
  • 2 Web of Science
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Predictive factors for the diagnosis of autoimmune pancreatitis using endoscopic ultrasound-guided tissue acquisition: a retrospective study in Japan
Keisuke Yonamine, Shinsuke Koshita, Yoshihide Kanno, Takahisa Ogawa, Hiroaki Kusunose, Toshitaka Sakai, Kazuaki Miyamoto, Fumisato Kozakai, Haruka Okano, Yuto Matsuoka, Kento Hosokawa, Hidehito Sumiya, Yutaka Noda, Kei Ito
Clin Endosc 2025;58(3):457-464.   Published online March 28, 2025
DOI: https://doi.org/10.5946/ce.2024.238
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: The factors affecting the detection rate of lymphoplasmacytic sclerosing pancreatitis (LPSP) using endoscopic ultrasound-guided tissue acquisition (EUS-TA) in patients with type 1 autoimmune pancreatitis (AIP) have not been thoroughly studied. Therefore, we conducted a retrospective study to identify the predictive factors for histologically detecting level 1 or 2 LPSP using EUS-TA.
Methods
Fifty patients with AIP were included in this study, and the primary outcome measures were the predictive factors for histologically detecting level 1 or 2 LPSP using EUS-TA.
Results
Multivariate analysis identified the use of fine needle biopsy (FNB) needles as a significant predictive factor for LPSP detection (odds ratio, 15.1; 95% confidence interval, 1.62–141; ¬¬p=0.017). The rate of good-quality specimens (specimen adequacy score ≥4) was significantly higher for the FNB needle group than for the fine needle aspiration (FNA) needle group (97% vs. 56%; p<0.01), and the FNB needle group required significantly fewer needle passes than the FNA needle group (median, 2 vs. 3; p<0.01).
Conclusions
The use of FNB needles was the most important factor for the histological confirmation of LPSP using EUS-TA in patients with type 1 AIP.

Citations

Citations to this article as recorded by  
  • A new era for autoimmune pancreatitis diagnosis: fine-needle biopsy outperforms fine-needle aspiration in endoscopic ultrasound-guided tissue acquisition
    Gunn Huh, Tae Jun Song
    Clinical Endoscopy.2025; 58(3): 406.     CrossRef
  • 2,458 View
  • 163 Download
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  • 1 Crossref
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In-room cytologic evaluation by trained endosonographer for determination of procedure end in endoscopic ultrasound-guided fine needle biopsy of solid pancreatic lesions: a prospective study in Taiwan
Weng-Fai Wong, Yu-Ting Kuo, Wern-Cherng Cheng, Chia-Tung Shun, Ming-Lun Han, Chieh-Chang Chen, Hsiu-Po Wang
Clin Endosc 2025;58(3):465-473.   Published online December 12, 2024
DOI: https://doi.org/10.5946/ce.2024.143
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) is an essential tool for tissue acquisition in solid pancreatic tumors. Rapid on-site evaluation (ROSE) by cytologists ensures diagnostic accuracy. However, the universal application of the ROSE is limited by its availability. Therefore, we aimed to investigate the feasibility of determining the end of the procedure based on the results of in-room cytological evaluation by trained endosonographers (IRCETE).
Methods
A training course focusing on the cytological interpretation of common pancreatic tumors was provided to the three endosonographers. After training, the decision to terminate EUS-FNB was made based on IRCETE results. The diagnostic accuracy, concordance rate of diagnostic categories, and sample adequacy were compared with those determined by board-certified cytologists and macroscopic on-site evaluation (MOSE).
Results
We enrolled 65 patients with solid pancreatic tumors, most of whom were malignant (86.2%). The diagnostic accuracy was 90.8% when the end of the procedure was determined based on IRCETE, compared to 87.7% and 98.5% when determined by MOSE and cytologists, respectively (p=0.060). Based on the cytologists’ results, the accuracy of IRCETE in diagnostic category interpretation was 97.3%.
Conclusions
In the absence of ROSE, IRCETE can serve as a supplementary alternative to MOSE in determining the end of tissue sampling with a high accuracy rate.

Citations

Citations to this article as recorded by  
  • Diagnostic accuracy and sensitivity of the rapid on-site evaluation (ROSE) versus macroscopic on-site evaluation (MOSE) in endoscopic ultrasound (EUS)-guided sampling: a systematic review
    Eyad Gadour, Bogdan Miutescu, Sarah Al Ghamdi, Calin Burciu, Hossam Shaaban, Deiana Vuletici, Aymen Almuhaidb, Iulia Ratiu, Emad Aljahdli, Hussein Okasha
    Frontline Gastroenterology.2025; 16(6): 489.     CrossRef
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Clinical utility of endoscopic ultrasound-guided tissue acquisition for comprehensive genomic profiling of patients with biliary tract cancer, especially with intrahepatic cholangiocarcinoma
Takafumi Yanaidani, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Yasuhiro Kuraishi, Nobumasa Mizuno, Sho Ishikawa, Masanori Yamada, Tsukasa Yasuda
Clin Endosc 2024;57(3):384-392.   Published online February 15, 2024
DOI: https://doi.org/10.5946/ce.2023.139
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is a standard diagnostic method for biliary tract cancer (BTC), and samples obtained in this manner may be used for comprehensive genomic profiling (CGP). This study evaluated the utility of EUS-TA for CGP in a clinical setting and determined the factors associated with the adequacy of CGP in patients with BTC.
Methods
CGP was attempted for 105 samples from 94 patients with BTC at the Aichi Cancer Center, Japan, from October 2019 to April 2022.
Results
Overall, 77.1% (81/105) of the samples were adequate for CGP. For 22-G or 19-G fine-needle biopsy (FNB), the sample adequacy was 85.7% (36/42), which was similar to that of surgical specimens (94%, p=0.45). Univariate analysis revealed that 22-G or larger FNB needle usage (86%, p=0.003), the target primary lesions (88%, p=0.015), a target size ≥30 mm (100%, p=0.0013), and number of punctures (90%, p=0.016) were significantly positively associated with CGP sample adequacy.
Conclusions
EUS-TA is useful for CGP tissue sampling in patients with BTC. In particular, the use of 22-G or larger FNB needles may allow for specimen adequacy comparable to that of surgical specimens.

Citations

Citations to this article as recorded by  
  • Adequacy evaluation of 22‐gauge needle endoscopic ultrasound‐guided tissue acquisition samples and glass slides preparation for successful comprehensive genomic profiling testing: A single institute experience
    Tami Nagatani, Yoji Wani, Masahiro Takatani, Soichiro Fushimi, Hirofumi Inoue, Shinichiro Hori, Kyohei Kai, Hideki Yamamoto, Tetsuya Okazaki, Maki Tanioka, Hiroyuki Okada, Akira Hirasawa
    DEN Open.2026;[Epub]     CrossRef
  • Tissue-preserving sectioning as the tip of comprehensive genomic profiling testing using biliary tract cancer tissue obtained by 22-gauge endoscopic ultrasound tissue acquisition
    Yoji Wani, Tami Nagatani, Masahiro Takatani
    Clinical Endoscopy.2026; 59(1): 160.     CrossRef
  • A rare case of needle tract seeding following endoscopic ultrasound‐guided tissue acquisition for cholangiocarcinoma
    Tatsunori Satoh, Haruna Takahashi, Shinya Kawaguchi
    Journal of Hepato-Biliary-Pancreatic Sciences.2025;[Epub]     CrossRef
  • Enhancing comprehensive genome profiling of liver tumors using endoscopic ultrasound-guided fine-needle biopsy
    Fumitaka Niiya, Akihiro Nakamura, Yasuo Ueda, Takafumi Ogawa, Naoki Tamai, Masataka Yamawaki, Jun Noda, Tetsushi Azami, Yuichi Takano, Masatsugu Nagahama
    Endoscopy International Open.2025;[Epub]     CrossRef
  • Recent Advances in Endoscopic Ultrasound-Guided Tissue Acquisition
    Panotpol Termsinsuk, Nonthalee Pausawasdi
    Journal of Digestive Endoscopy.2025;[Epub]     CrossRef
  • Is genomic analysis possible in a tissue acquired via endoscopic ultrasound-guided fine-needle biopsy in cholangiocarcinoma?
    Jonghyun Lee, Sung Yong Han
    Clinical Endoscopy.2024; 57(3): 332.     CrossRef
  • Utility of Transpapillary Biopsy and Endoscopic Ultrasound-Guided Tissue Acquisition for Comprehensive Genome Profiling of Unresectable Biliary Tract Cancer
    Soma Fukuda, Susumu Hijioka, Yoshikuni Nagashio, Daiki Yamashige, Daiki Agarie, Yuya Hagiwara, Kohei Okamoto, Shin Yagi, Yasuhiro Komori, Masaru Kuwada, Yuta Maruki, Chigusa Morizane, Hideki Ueno, Nobuyoshi Hiraoka, Kiichiro Tsuchiya, Takuji Okusaka
    Cancers.2024; 16(16): 2819.     CrossRef
  • Endoscopic Ultrasound and Intraductal Ultrasound in the Diagnosis of Biliary Tract Diseases: A Narrative Review
    Akiya Nakahata, Yasunobu Yamashita, Masayuki Kitano
    Diagnostics.2024; 14(18): 2086.     CrossRef
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The role of needle-based confocal laser endomicroscopy in the diagnosis of pancreatic neuroendocrine tumors
Masanori Yamada, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Tsukasa Yasuda, Toshitaka Fukui
Clin Endosc 2024;57(3):393-401.   Published online September 12, 2023
DOI: https://doi.org/10.5946/ce.2023.068
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a highly accurate method for diagnosing pancreatic neuroendocrine tumors (PNETs); however, some PNETs are difficult to diagnose. Recently, the efficacy of needle-based confocal laser endomicroscopy (nCLE) in diagnosing solid pancreatic masses has been reported. However, the efficacy of nCLE in the diagnosis of PNETs remains unknown and only a small number of cases have been reported. Hence, this study aimed to evaluate the efficacy of nCLE in the diagnosis of PNETs.
Methods
This single-center retrospective study evaluated 30 consecutive patients with suspected PNETs on contrast-enhanced computed tomography, who consented to nCLE combined with EUS-FNA and were diagnosed using EUS-FNA or surgical resection. The diagnostic criteria for PNETs using nCLE were based on the nesting and trabecular and glandular arrangement of tumor cell clusters surrounded by capillary vessels and fibrosis, as reported in previous studies.
Results
The diagnosis using nCLE was classified into three categories: misdiagnosis in three cases (10%), non-diagnostic in six cases (20%), and diagnostic in 21 cases (70%). nCLE was able to diagnose PNET in one of the two cases with inconclusive EUS-FNA.
Conclusions
Although further development of the resolution and optimization of the diagnostic criteria are required, nCLE may constitute a useful diagnostic option in cases of inconclusive EUS-FNA for PNETs.

Citations

Citations to this article as recorded by  
  • Recent Advances in Endoscopic Ultrasound (EUS) for Pancreatic Cystic Lesions
    Veeral M. Oza, Anuroop Yekula, Truptesh H. Kothari
    Journal of Digestive Endoscopy.2026;[Epub]     CrossRef
  • Recent developments in the diagnosis of pancreatic neuroendocrine neoplasms
    Anna Battistella, Matteo Tacelli, Paola Mapelli, Marco Schiavo Lena, Valentina Andreasi, Luana Genova, Francesca Muffatti, Francesco De Cobelli, Stefano Partelli, Massimo Falconi
    Expert Review of Gastroenterology & Hepatology.2024; 18(4-5): 155.     CrossRef
  • Advancements and challenges in gastrointestinal imaging
    Eun Jeong Gong, Chang Seok Bang
    World Journal of Clinical Cases.2024; 12(33): 6591.     CrossRef
  • 5,203 View
  • 147 Download
  • 2 Web of Science
  • 3 Crossref
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A multicenter comparative study of endoscopic ultrasound-guided fine-needle biopsy using a Franseen needle versus conventional endoscopic ultrasound-guided fine-needle aspiration to evaluate microsatellite instability in patients with unresectable pancreatic cancer
Tadayuki Takagi, Mitsuru Sugimoto, Hidemichi Imamura, Yosuke Takahata, Yuki Nakajima, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Jun Nakamura, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Ryoichiro Kobashi, Yuko Hashimoto, Goro Shibukawa, Shigeru Marubashi, Takuto Hikichi, Hiromasa Ohira
Clin Endosc 2023;56(1):107-113.   Published online January 16, 2023
DOI: https://doi.org/10.5946/ce.2022.019
AbstractAbstract PDFPubReaderePub
Background
/Aims: Immune checkpoint blockade has recently been reported to be effective in treating microsatellite instability (MSI)-high tumors. Therefore, sufficient sampling of histological specimens is necessary in cases of unresectable pancreatic cancer (UR-PC). This multicenter study investigated the efficacy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) using a Franseen needle for MSI evaluation in patients with UR-PC.
Methods
A total of 89 patients with UR-PC who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or EUS-FNB using 22-G needles at three hospitals in Japan (2018–2021) were enrolled. Fifty-six of these patients (FNB 23 and FNA 33) were followed up or evaluated for MSI. Patient characteristics, UR-PC data, and procedural outcomes were compared between patients who underwent EUS-FNB and those who underwent EUS-FNA.
Results
No significant difference in terms of sufficient tissue acquisition for histology was observed between patients who underwent EUS-FNB and those who underwent EUS-FNA. MSI evaluation was possible significantly more with tissue samples obtained using EUS-FNB than with tissue samples obtained using EUS-FNA (82.6% [19/23] vs. 45.5% [15/33], respectively; p<0.01). In the multivariate analysis, EUS-FNB was the only significant factor influencing the possibility of MSI evaluation.
Conclusions
EUS-FNB using a Franseen needle is desirable for ensuring sufficient tissue acquisition for MSI evaluation.

Citations

Citations to this article as recorded by  
  • Lymphadenopathy Tissue Sampling by EUS-Guided Fine-Needle Biopsy Contributes to Meeting the Conditions for Genomic Profiling
    Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Jun Nakamura, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Yuko Hashimoto, Takuto Hikichi, Hiromasa Ohira
    Journal of Clinical Gastroenterology.2025; 59(4): 369.     CrossRef
  • Adverse events of 20–22G second‐generation endoscopic ultrasound‐guided fine‐needle biopsy needles for solid lesions in the upper gastrointestinal tract and adjacent organs: Systematic review and meta‐analysis
    Cheng‐ye Pan, Shi‐min Wang, Dong‐hao Cai, Jia‐yi Ma, Shi‐yu Li, Yibin Guo, Sun Jing, Jin Zhendong, Kaixuan Wang
    Digestive Endoscopy.2025; 37(5): 490.     CrossRef
  • Benefits of macroscopic on-site evaluation in endoscopic ultrasound-guided tissue acquisition for comprehensive genomic profiling
    Junya Sato, Hirotoshi Ishiwatari, Kazuma Ishikawa, Hiroki Sakamoto, Takuya Doi, Masahiro Yamamura, Kazunori Takada, Yoichi Yamamoto, Masao Yoshida, Sayo Ito, Noboru Kawata, Kenichiro Imai, Kinichi Hotta, Hiroyuki Ono
    Endoscopy International Open.2025;[Epub]     CrossRef
  • Oil blotting paper for formalin fixation increases endoscopic ultrasound‐guided tissue acquisition‐collected sample volumes on glass slides
    Takuo Yamai, Kenji Ikezawa, Yusuke Seiki, Ko Watsuji, Yasuharu Kawamoto, Takeru Hirao, Kazuma Daiku, Shingo Maeda, Makiko Urabe, Yugo Kai, Ryoji Takada, Kaori Mukai, Tasuku Nakabori, Hiroyuki Uehara, Sayoko Tsuzaki, Ayumi Ryu, Satoshi Tanada, Shigenori Na
    Cancer Medicine.2024;[Epub]     CrossRef
  • MSI-H Detection by ddPCR in Endoscopic Ultrasound Fine Needle Biopsy (EUS-FNB) from Pancreatic Ductal Adenocarcinoma
    Maria Assunta Piano, Elisa Boldrin, Lidia Moserle, Nicoletta Salerno, Dalila Fanelli, Giulia Peserico, Maria Raffaella Biasin, Giovanna Magni, Veronica Varano, Giorgia Zalgelli, Vasileios Mourmouras, Antonio Rosato, Antonio Scapinello, Alberto Fantin, Mat
    International Journal of Molecular Sciences.2024; 25(20): 11090.     CrossRef
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Comparison of diagnostic performances of slow-pull suction and standard suction in endoscopic ultrasound-guided fine needle biopsy for gastrointestinal subepithelial tumors
Joon Seop Lee, Chang Min Cho, Yong Hwan Kwon, An Na Seo, Han Ik Bae, Man-Hoon Han
Clin Endosc 2022;55(5):637-644.   Published online August 17, 2022
DOI: https://doi.org/10.5946/ce.2021.257
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is integral to the diagnosis of gastrointestinal (GI) subepithelial tumors (SETs). The impact of different EUS-FNB tissue sampling techniques on specimen adequacy and diagnostic accuracy in SETs has not been fully evaluated. This study aimed to compare the diagnostic outcomes of slow-pull (SP) and standard suction (SS) in patients with GI SETs.
Methods
In this retrospective comparative study, 54 patients were enrolled. Medical records were reviewed for location and size of the target lesion, FNB needle type/size, technical order, specimen adequacy, diagnostic yield, and adverse events. The acquisition rate of adequate specimens and diagnostic accuracy were compared according to EUS-FNB techniques.
Results
The mean lesion size was 42.6±36.4 mm, and most patients were diagnosed with GI stromal tumor (75.9%). The overall diagnostic accuracies of the SP and SS techniques were 83.3% and 81.5%, respectively (p=0.800). The rates of obtaining adequate core tissue were 79.6% and 75.9%, respectively (p=0.799). No significant clinical factors affected the rate of obtaining adequate core tissue, including lesion location and size, FNB needle size, and final diagnosis.
Conclusions
SP and SS had comparable diagnostic accuracies and adequate core tissue acquisition for GI SETs via EUS-FNB.

Citations

Citations to this article as recorded by  
  • Advancements in endoscopic resection of subepithelial tumors: toward safer, recurrence-free techniques
    Won Shik Kim, Moon Kyung Joo
    Clinical Endoscopy.2025; 58(2): 256.     CrossRef
  • Current Practices in Histological Diagnosis and Management of Asymptomatic Gastric Subepithelial Lesions: A Multicenter Survey in Korea
    Sang Hoon Kim, Jae Yong Park, Ayoung Lee, Bong Eun Lee, Byung-Hoon Min, Chan Hyuk Park, Da Hyun Jung, Hyeong Ho Jo, Hyunsoo Chung, In Hyuk Yoo, Seon Young Park, Seung-Woo Lee, Yonghoon Choi, Jeong Hoon Lee, Seung Han Kim, Jae Myung Park, Joon Sung Kim, Su
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2025; 25(2): 159.     CrossRef
  • Endoscopic ultrasound-guided fine-needle aspiration for gastrointestinal subepithelial lesions
    Takuto Hikichi, Minami Hashimoto, Takumi Yanagita, Tsunetaka Kato, Jun Nakamura
    Journal of Medical Ultrasonics.2024; 51(2): 195.     CrossRef
  • What method can we choose if rapid on-site evaluation is not available for the endoscopic ultrasound-guided tissue acquisition of upper gastrointestinal subepithelial lesions?
    Yu Kyung Cho
    Clinical Endoscopy.2024; 57(1): 53.     CrossRef
  • The Diagnostic Approach of Benign Esophageal Tumors: A Narrative Review
    Alex R. Jones, Preksha Vankawala, Tarek Sawas
    Current Treatment Options in Gastroenterology.2024; 22(2): 44.     CrossRef
  • Diagnostic yield of endoscopic and EUS-guided biopsy techniques in subepithelial lesions of the upper GI tract: a systematic review
    Cynthia A. Verloop, Jacqueline A.C. Goos, Marco J. Bruno, Rutger Quispel, Lydi M.J.W. van Driel, Lieke Hol
    Gastrointestinal Endoscopy.2024; 99(6): 895.     CrossRef
  • EUS‐guided tissue acquisition from gastric subepithelial lesions—The optimal technique still remains undecided
    Suprabhat Giri, Sridhar Sundaram
    Australasian Journal of Ultrasound in Medicine.2024; 27(4): 263.     CrossRef
  • An Esophageal Leiomyoma with Cystic Degeneration Mimicking a Malignant Neoplasm
    Gwang Ha Kim, Dong Chan Joo, Moon Won Lee, Bong Eun Lee, Kyungbin Kim
    The Ewha Medical Journal.2023;[Epub]     CrossRef
  • Prevalence, natural progression, and clinical practices of upper gastrointestinal subepithelial lesions in Korea: a multicenter study
    Younghee Choe, Yu Kyung Cho, Gwang Ha Kim, Jun-Ho Choi, Eun Soo Kim, Ji Hyun Kim, Eun Kwang Choi, Tae Hyeon Kim, Seong-Hun Kim, Do Hoon Kim
    Clinical Endoscopy.2023; 56(6): 744.     CrossRef
  • 5,437 View
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  • 6 Web of Science
  • 9 Crossref
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Systematic Review and Meta-Analysis
Mucosal incision-assisted biopsy versus endoscopic ultrasound-assisted tissue acquisition for subepithelial lesions: a systematic review and meta-analysis
Suprabhat Giri, Shivaraj Afzalpurkar, Sumaswi Angadi, Sridhar Sundaram
Clin Endosc 2022;55(5):615-625.   Published online August 4, 2022
DOI: https://doi.org/10.5946/ce.2022.133
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Mucosal incision-assisted biopsy (MIAB) for tissue acquisition (TA) from subepithelial lesions (SELs) is emerging as an alternative to endoscopic ultrasound (EUS)-guided TA. Only a limited number of studies compared the diagnostic utility of MIAB and EUS for upper gastrointestinal (GI) SELs; therefore, we conducted this systematic review and meta-analysis.
Methods
A comprehensive literature search from January 2020 to January 2022 was performed to compare the diagnostic accuracy and safety of MIAB and EUS-guided TA for upper GI SELs.
Results
Seven studies were included in this meta-analysis. The pooled technical success rate (risk ratio [RR], 0.96; 95% confidence interval [CI], 0.89–1.04) and procedural time (mean difference=–4.53 seconds; 95% CI, –22.38 to 13.31] were comparable between both the groups. The overall chance of obtaining a positive diagnostic yield was lower with EUS than with MIAB for all lesions (RR, 0.83; 95% CI, 0.71–0.98) but comparable when using a fine-needle biopsy needle (RR, 0.93; 95% CI, 0.83–1.04). The positive diagnostic yield of MIAB was higher for lesions <20 mm (RR, 0.75; 95% CI, 0.63–0.89). Six studies reported no adverse events.
Conclusions
MIAB can be considered an effective alternative to EUS-guided TA for upper GI SELs without an increased risk of adverse events.

Citations

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    Alex R. Jones, Preksha Vankawala, Tarek Sawas
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    Bernhard Morell, Frans Olivier The, Christoph Gubler, Fritz Ruprecht Murray
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  • Diagnostic yield of endoscopic and EUS-guided biopsy techniques in subepithelial lesions of the upper GI tract: a systematic review
    Cynthia A. Verloop, Jacqueline A.C. Goos, Marco J. Bruno, Rutger Quispel, Lydi M.J.W. van Driel, Lieke Hol
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    Tanyaporn Chantarojanasiri, Nikhil Sonthalia, Rashid N. Lui
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    Suprabhat Giri, Sridhar Sundaram
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  • Endoscopic Ultrasound and Gastric Sub-Epithelial Lesions: Ultrasonographic Features, Tissue Acquisition Strategies, and Therapeutic Management
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    Moon Won Lee, Bong Eun Lee
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    Modesto Varas Lorenzo, Ramón Abad Belando
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Original Articles
Comparison of tube-assisted mapping biopsy with digital single-operator peroral cholangioscopy for preoperative evaluation of biliary tract cancer
Tsuyoshi Takeda, Takashi Sasaki, Takafumi Mie, Takeshi Okamoto, Chinatsu Mori, Takaaki Furukawa, Yuto Yamada, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
Clin Endosc 2022;55(4):549-557.   Published online July 20, 2022
DOI: https://doi.org/10.5946/ce.2021.227
AbstractAbstract PDFPubReaderePub
Background
/Aims: Digital single-operator cholangioscopy (DSOC)-guided mapping biopsy (DMB) and tube-assisted mapping biopsy (TMB) are two techniques used for preoperative evaluation of biliary tract cancer (BTC). However, data regarding the diagnostic performance of these techniques are limited.
Methods
We retrospectively examined consecutive patients with BTC who underwent either technique at our institution between 2018 and 2020. We evaluated the technical success rate, adequate tissue acquisition rate, and diagnostic performance of these techniques for the evaluation of lateral spread of BTC.
Results
A total of 54 patients were included in the study. The technical success rate of reaching the target sites was 95% for DMB and 100% for TMB. The adequate tissue acquisition rate was 61% for DMB and 69% for TMB. The adequate tissue acquisition rate was low, especially for target sites beyond the secondary biliary radicles. The sensitivity of DMB alone was 39%, which improved to 65% when combined with visual impression. Experts demonstrated a higher negative predictive value and diagnostic accuracy with respect to both DSOC visual impression and DMB for the evaluation of lateral spread of BTC compared to trainees.
Conclusions
Adequate tissue acquisition rates were similar between the two techniques. Since DMB requires expertise, TMB may be an acceptable option when DSOC is unavailable or when DSOC expertise is limited.

Citations

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  • Clinical Practice Guidelines for Peroral Cholangioscopy
    Kazumasa Nagai, Akio Katanuma, Shomei Ryozawa, Yoshinobu Okabe, Naoki Okano, Hiroki Kawashima, Hiroshi Kawakami, Hironari Kato, Nobuhiko Hayashi, Atsushi Irisawa, Etsuro Hatano, Ichiro Yasuda, Yoshinori Igarashi, Takao Itoi
    Journal of Hepato-Biliary-Pancreatic Sciences.2026; 33(1): 58.     CrossRef
  • Utility of a novel sheath designed for mapping biopsy for preoperative malignant hilar biliary obstruction
    Hiroki Sakamoto, Hirotoshi Ishiwatari, Masahiro Yamamura, Takuya Doi, Junya Sato, Yuko Kakuda, Tomoko Norose, Nobuyuki Oike, Teiichi Sugiura, Katsuhiko Uesaka
    Endoscopy International Open.2026;[Epub]     CrossRef
  • Usefulness of a novel 11F digital single‐operator cholangioscopy through a colonoscope in a patient with surgically altered anatomy
    Takafumi Mie, Tsuyoshi Takeda, Takashi Sasaki
    Digestive Endoscopy.2025; 37(4): 438.     CrossRef
  • Dose Performing Multiple Biopsy Strokes From the Same Site Improve Specimen Adequacy in Cholangioscopy‐Guided Mapping Biopsy for Extrahepatic Cholangiocarcinoma?
    Takahisa Ogawa, Yoshihide Kanno, Shinsuke Koshita, Hiroaki Kusunose, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Haruka Okano, Kento Hosokawa, Hidehito Sumiya, Yutaka Noda, Kei Ito
    JGH Open.2025;[Epub]     CrossRef
  • Utility of a novel tapered-tip sheath system for preoperative mapping biopsy of biliary tract cancers
    Tomoaki Matsumori, Norimitsu Uza, Kazuhiro Okada, Masahiro Shiokawa, Takahisa Maruno, Yoshihiro Nishikawa, Takeshi Kuwada, Yuya Muramoto, Muneji Yasuda, Hajime Yamazaki, Kojiro Taura, Etsuro Hatano, Yuzo Kodama, Hiroshi Seno
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    Hironori Aoi, Kentaro Yamao, Takuya Ishikawa, Yasuyuki Mizutani, Tadashi Iida, Kota Uetsuki, Yoshihisa Takada, Takeshi Yamamura, Kazuhiro Furukawa, Masanao Nakamura, Hiroki Kawashima
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    Raymond S. Y. Tang
    Digestive Endoscopy.2024; 36(7): 778.     CrossRef
  • Cholangioscopy for biliary diseases
    Aymeric Becq, Adil Soualy, Marine Camus
    Current Opinion in Gastroenterology.2023; 39(2): 67.     CrossRef
  • 5,874 View
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  • 8 Web of Science
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Confirming Whether Fine Needle Biopsy Device Shortens the Learning Curve of Endoscopic Ultrasound-Guided Tissue Acquisition Without Rapid Onsite Evaluation
Meng-Ying Lin, Cheng-Lin Wu, Mitsuhiro Kida, Wei-Lun Chang, Bor-Shyang Sheu
Clin Endosc 2021;54(3):420-427.   Published online May 28, 2021
DOI: https://doi.org/10.5946/ce.2020.184
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasonography (EUS)-guided tissue acquisition requires a long learning curve. We aimed to compare the skill maturation curves between fine needle aspiration (FNA) and biopsy (FNB) for tissue acquisition.
Methods
The initial 60 procedures performed by the trainee endosonographer (30 FNA vs. 30 FNB) were consecutively enrolled. The difference in procedure performance was compared between the two groups. Learning curves were assessed. Twenty additional cases were subsequently enrolled to assess the consistency of performance in the FNB group.
Results
The FNB group acquired larger tissue samples (2.35 vs. 0.70 mm2; p<0.001) with lower blood content (p=0.001) and higher tissue quality (p=0.017) compared with the FNA group. In addition, the FNB group required less needle pass to establish a diagnosis (2.43 vs. 2.97; p=0.006). A threshold diagnostic sensitivity of ≥80% was achieved after performing 10 FNB procedures. The number of needle passes significantly decreased after conducting 20 FNB procedures (1.80 vs. 2.70; p=0.041). The diagnostic sensitivity and number of needle passes remained the same in the subsequent FNB procedures. By contrast, this skill maturation phenomenon was not observed after performing 30 FNA procedures.
Conclusions
In EUS-guided tissue acquisition, the FNB needle was more efficient and thus shortened the learning curve of EUSguided tissue acquisition in trainee endosonographers.

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  • Identification of Endosonographic Features that Compromise EUS-FNB Diagnostic Accuracy in Pancreatic Masses
    Hsueh-Chien Chiang, Chien-Jui Huang, Yao-Shen Wang, Chun-Te Lee, Meng-Ying Lin, Wei-Lun Chang
    Digestive Diseases and Sciences.2024; 69(11): 4302.     CrossRef
  • Tissue Quality Comparison Between Heparinized Wet Suction and Dry Suction in Endoscopic Ultrasound-Fine Needle Biopsy of Solid Pancreatic Masses: A Randomized Crossover Study
    Meng-Ying Lin, Cheng-Lin Wu, Yung-Yeh Su, Chien-Jui Huang, Wei-Lun Chang, Bor-Shyang Sheu
    Gut and Liver.2023; 17(2): 318.     CrossRef
  • Factors Affecting the Learning Curve in the Endoscopic Ultrasound-Guided Sampling of Solid Pancreatic Lesions: A Prospective Study
    Marcel Razpotnik, Simona Bota, Mathilde Kutilek, Gerolf Essler, Christian Urak, Julian Prosenz, Jutta Weber-Eibel, Andreas Maieron, Markus Peck-Radosavljevic
    Gut and Liver.2023; 17(2): 308.     CrossRef
  • Investigation into the content of red material in EUS-guided pancreatic cancer biopsies
    Meng-Ying Lin, Yung-Yeh Su, Yu-Ting Yu, Chien-Jui Huang, Bor-Shyang Sheu, Wei-Lun Chang
    Gastrointestinal Endoscopy.2023; 97(6): 1083.     CrossRef
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Case Reports
Acute Liver Failure Secondary to Hepatic Infiltration of Malignant Melanoma
Yujin Lee, Jaekwang Lee, Hyunsoo Kim, Changkeun Park, Jaekwon Jung, Daejin Kim, Yun Jin Chung, Hanjun Ryu
Clin Endosc 2022;55(2):287-291.   Published online April 1, 2021
DOI: https://doi.org/10.5946/ce.2020.272
AbstractAbstract PDFPubReaderePub
Acute liver failure due to malignant melanoma is uncommon. We presents a case of acute liver failure secondary to hepatic infiltration of a malignant melanoma. An 86-year-old man was admitted with elevated liver enzymes and an increased lactate dehydrogenase level. His condition progressed to acute liver failure, but the etiology of liver failure was unclear. Esophagogastroduodenoscopy was performed to evaluate dyspepsia, which showed signs indicative of malignant melanoma. Based on the endoscopy findings and elevated liver enzyme levels, liver biopsy was performed to confirm the presence of malignant melanoma. Hepatic infiltration of malignant melanoma was observed histologically. However, massive and diffuse liver metastasis is very rare and difficult to identify on imaging studies. If the etiology of liver failure is unclear, diffuse metastatic melanoma infiltration should be considered as differential diagnosis. Early liver biopsy can help to clarify the diagnosis.

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  • “Hot Liver” in Hepar Lobatum Carcinomatosum on [18F]FDG PET-CT
    Maxime Guedj, Ondine Dufour, Emmanuelle Charafe-Jauffret, Jacques Ewald, Nathalie Charrier
    Clinical Nuclear Medicine.2026;[Epub]     CrossRef
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    Viktor Domislovic, Vibor Sesa, Iva Kosuta, Stela Bulimbasic, Anna Mrzljak
    World Journal of Clinical Cases.2025;[Epub]     CrossRef
  • HEPATOPATHY SECONDARY TO INFILTRATION BY MALIGNANT MELANOMA: DIAGNOSTIC VALUE OF LIVER BIOPSY
    Alejandro García Martínez, Álvaro Morales Prado, Jorge Martínez-Echevarría Gil-Delgado, Daniel Mateos Millán
    Revista Española de Enfermedades Digestivas.2024;[Epub]     CrossRef
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    Robert S. O’Neill, Phillip Leaver, Connor Ryan, Sharron Liang, Santosh Sanagapalli, Rasha Cosman
    Clinical Journal of Gastroenterology.2024; 17(6): 1125.     CrossRef
  • Tumor lysis syndrome with hepatic failure- A rare presentation of undiagnosed metastatic melanoma
    Nicholas Cochran-Caggiano, Brandon Zaffuto, Ryan Dean
    JEM Reports.2023; 2(1): 100009.     CrossRef
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    Rocío González Grande, Ana Bravo Aranda, Inmaculada Santaella Leiva, Susana López Ortega, Miguel Jiménez Pérez
    Seminars in Oncology.2023; 50(3-5): 71.     CrossRef
  • 6,915 View
  • 163 Download
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  • 6 Crossref
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Micro-Biopsy Forceps in the Assessment of Peritoneal Carcinomatosis: A Possible New Indication?
Cecilia Binda, Emanuele Dabizzi, Emanuele Sinagra, Adele Fornelli, Luca Saragoni, Vincenzo Cennamo, Andrea Anderloni, Carlo Fabbri
Clin Endosc 2021;54(4):613-617.   Published online March 25, 2021
DOI: https://doi.org/10.5946/ce.2020.241
AbstractAbstract PDFPubReaderePub
Peritoneal carcinomatosis (PC) is defined as a metastatic involvement of the peritoneum by several other primary sites and it is characterized by a marked worsening of prognosis, with limited treatment opportunities. Subsequently, PC should be ruled out before any invasive treatment is administered. A new through-the-needle micro-biopsy forceps (MF) was recently introduced that permits micro-histology cores. In this case series, we evaluated the feasibility of MF in the assessment of PC to complete patient diagnostic work-ups. Five consecutive patients referred for endoscopic ultrasound staging were sampled using MF. Sampling was feasible in all patients with a technical success of 100%. No adverse events were reported in any cases. This technique was feasible and safe with a technical success rate of 100%. It permitted sampling of peritoneal irregularity, obtained high-quality tissue fragments in all cases, and enabled an additional assessment, i.e., immunohistochemical staining.

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  • Current perspectives on the diversification of endoscopic ultrasound-guided fine-needle aspiration and biopsy
    Shinpei DOI, Takako ADACHI, Ayako WATANABE, Nobuhiro KATSUKURA, Takayuki TSUJIKAWA
    Choonpa Igaku.2025;[Epub]     CrossRef
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    Shinpei Doi, Takako Adachi, Ayako Watanabe, Nobuhiro Katsukura, Takayuki Tsujikawa
    Journal of Medical Ultrasonics.2024; 51(2): 235.     CrossRef
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    Pradermchai Kongkam, Theerapat Orprayoon, Sirilak Yooprasert, Nakarin Sirisub, Naruemon Klaikaew, Anapat Sanpawat, Shahram Safa, Wiriyaporn Ridtitid, Pinit Kullavanijaya, Rungsun Rerknimitr
    BMC Gastroenterology.2021;[Epub]     CrossRef
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  • 3 Crossref
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Original Articles
High Sensitivity of Endoscopic Ultrasound-Guided Fine-Needle Aspiration and Endoscopic Ultrasound-Guided Fine-Needle Biopsy in Lymphadenopathy Caused by Metastatic Disease: A Prospective Comparative Study
Per Hedenström, Vasilis Chatzikyriakos, Roozbeh Shams, Catarina Lewerin, Riadh Sadik
Clin Endosc 2021;54(5):722-729.   Published online March 4, 2021
DOI: https://doi.org/10.5946/ce.2020.283
AbstractAbstract PDFPubReaderePub
Background
/Aims: The diagnostic work-up of lymphadenopathy is challenging but important to determine the correct therapy. Nevertheless, few studies have addressed the topic of endosonography (EUS)-guided tissue acquisition in lymphadenopathy. Therefore, we aimed to evaluate the accuracy and safety of EUS-guided fine-needle biopsy sampling (EUS-FNB) in intrathoracic and intraabdominal lymphadenopathy.
Methods
In a tertiary care center, patients with lymphadenopathy referred for EUS-guided sampling were included prospectively from 2014 to 2019 (NCT02360839). In all cases, EUS-FNB (22 gauge) and EUS-guided fine-needle aspiration (EUS-FNA) (25 gauge) were performed. The patients were randomized to the first needle pass with FNB or FNA. Study outcomes were the diagnostic accuracy and adverse event rate.
Results
Forty-eight patients were included (median age: 69 years [interquartile range, 59–76]; 24/48 females [50%]). The final diagnoses were metastasis (n=17), lymphoma (n=11), sarcoidosis (n=6), and inflammatory disease (n=14). The diagnostic performance of the two modalities was comparable, including a high sensitivity for metastatic nodes (EUS-FNB: 87% vs. EUSFNA: 100%, p=0.5). The sensitivity for lymphoma was borderline superior in favor of EUS-FNB (EUS-FNB: 55% vs. EUS-FNA: 9%, p=0.06). No adverse events were recorded.
Conclusions
In lymphadenopathy, both EUS-FNB and EUS-FNA are safe and highly sensitive for metastatic lymph node detection. Lymphoma diagnosis is challenging regardless of the needle used.

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  • Lymphadenopathy Tissue Sampling by EUS-Guided Fine-Needle Biopsy Contributes to Meeting the Conditions for Genomic Profiling
    Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Jun Nakamura, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Yuko Hashimoto, Takuto Hikichi, Hiromasa Ohira
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    Dominique Béchade
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    Antonio Facciorusso, Marianna Arvanitakis, Stefano Francesco Crinò, Carlo Fabbri, Adele Fornelli, John Leeds, Livia Archibugi, Silvia Carrara, Jahnvi Dhar, Paraskevas Gkolfakis, Beate Haugk, Julio Iglesias Garcia, Bertrand Napoleon, Ioannis S. Papanikolao
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    Kirsty Cole, James A Gossage, Pradeep Bhandari, Natalie S Blencowe, Swathikan Chidambaram, Tom Crosby, Richard P T Evans, Ewen A Griffiths, Sivesh K Kamarajah, Sheraz R Markar, Nigel Trudgill, Timothy J Underwood, Philip H Pucher, Tarig Abdelrahman, Khali
    Diseases of the Esophagus.2025;[Epub]     CrossRef
  • Real-world outcomes of endoscopic ultrasound–guided tissue acquisition for actionable diagnosis in suspected primary or recurrent lymphoma
    Ho Seung Lee, Gunn Huh, Hyungwoo Cho, Sunguk Jang, John Vargo, Steven Edmundowicz, Dok Hyun Yoon, Do Hyun Park
    Gastrointestinal Endoscopy.2025;[Epub]     CrossRef
  • Transesophageal Bronchoscopic Ultrasound-guided Cryobiopsy (EUS-B-Cryo) for mediastinal lesions in critical airway obstruction: a case series with a systematic review
    Sanchit Mohan, A. J. Mahendran, Rohit Kumar, Manu Madan, Pranav Ish, Rajnish Kaushik, Nitesh Gupta
    Chest Disease Reports.2024;[Epub]     CrossRef
  • Comparison of 19-gauge conventional and Franseen needles for the diagnosis of lymphadenopathy and classification of malignant lymphoma using endoscopic ultrasound fine-needle aspiration
    Mitsuru Okuno, Keisuke Iwata, Tsuyoshi Mukai, Yusuke Kito, Takuji Tanaka, Naoki Watanabe, Senji Kasahara, Yuhei Iwasa, Akihiko Sugiyama, Youichi Nishigaki, Yuhei Shibata, Junichi Kitagawa, Takuji Iwashita, Eiichi Tomita, Masahito Shimizu
    Clinical Endoscopy.2024; 57(3): 364.     CrossRef
  • Diagnostic accuracy and safety of EUS-guided end-cutting fine-needle biopsy needles for tissue sampling of abdominal and mediastinal lymphadenopathies: a prospective multicenter series
    Silvia Carrara, Daoud Rahal, Kareem Khalaf, Tommy Rizkala, Glenn Koleth, Cristiana Bonifacio, Marta Andreozzi, Benedetto Mangiavillano, Francesco Auriemma, Paola Bossi, Monica Balzarotti, Antonio Facciorusso, Teresa Staiano, Elena Maldi, Marco Spadaccini,
    Gastrointestinal Endoscopy.2023; 98(2): 191.     CrossRef
  • Endoscopic Ultrasound-Guided Fine Needle Biopsy in the Diagnostic Work-Up of Deep-Seated Lymphadenopathies and Spleen Lesions: A Monocentric Experience
    Flaminia Bellisario, Fabia Attili, Fabrizia Campana, Federica Borrelli de Andreis, Silvia Bellesi, Elena Maiolo, Eleonora Alma, Rosalia Malafronte, Giuseppe Macis, Luigi Maria Larocca, Salvatore Annunziata, Francesco D’Alò, Stefan Hohaus
    Diagnostics.2023; 13(17): 2839.     CrossRef
  • Endoscopic ultrasound fine-needle biopsy vs fine-needle aspiration for lymph nodes tissue acquisition: a systematic review and meta-analysis
    Antonio Facciorusso, Stefano Francesco Crinò, Paraskevas Gkolfakis, Daryl Ramai, Andrea Lisotti, Ioannis S Papanikolaou, Benedetto Mangiavillano, Ilaria Tarantino, Andrea Anderloni, Carlo Fabbri, Konstantinos Triantafyllou, Pietro Fusaroli
    Gastroenterology Report.2022;[Epub]     CrossRef
  • A Novel Approach to Classification and Reporting of Lymph Node Fine-Needle Cytology: Application of the Proposed Sydney System
    Elena Vigliar, Gennaro Acanfora, Antonino Iaccarino, Massimo Mascolo, Daniela Russo, Giulia Scalia, Roberta Della Pepa, Claudio Bellevicine, Marco Picardi, Giancarlo Troncone
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  • Endoscopic Ultrasound Fine-Needle Biopsy versus Fine-Needle Aspiration for Tissue Sampling of Abdominal Lymph Nodes: A Propensity Score Matched Multicenter Comparative Study
    Antonio Facciorusso, Stefano Francesco Crinò, Nicola Muscatiello, Paraskevas Gkolfakis, Jayanta Samanta, Juliana Londoño Castillo, Christian Cotsoglou, Daryl Ramai
    Cancers.2021; 13(17): 4298.     CrossRef
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Comparison of Endoscopic Ultrasound-Guided Tissue Acquisition Using a 20-Gauge Menghini Needle with a Lateral Forward Bevel and a 22-Gauge Franseen Needle: A Single-Center Large Cohort Study
Takafumi Mie, Takashi Sasaki, Ryo Kanata, Takaaki Furukawa, Tsuyoshi Takeda, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
Clin Endosc 2021;54(5):730-738.   Published online March 4, 2021
DOI: https://doi.org/10.5946/ce.2020.251
AbstractAbstract PDFPubReaderePub
Background
/Aims: Several fine-needle biopsy (FNB) needles are available for endoscopic ultrasound (EUS)-guided tissue acquisition. However, there is disagreement on which type of needle has the best diagnostic yield. The aim of this study was to compare the performance and safety of two commonly used EUS-FNB needles.
Methods
We retrospectively analyzed consecutive patients who underwent EUS-FNB between June 2016 and March 2020 in our hospital. Two types of needles were evaluated: a 20-gauge Menghini needle with a lateral forward bevel and a 22-gauge Franseen needle. Rapid on-site evaluation was performed in all the cases. A multivariate analysis was performed to clarify the negative predictive factors for obtaining a histological diagnosis. Propensity score matching was performed to compare the diagnostic yields of these two needles.
Results
We analyzed 666 patients and 690 lesions. The overall diagnostic rate of histology alone was 88.8%, and the overall adverse event rate was 1.5%. Transduodenal access and small lesions (≤2 cm) were identified as negative predictive factors for obtaining a histological diagnosis. After propensity score matching, 482 lesions were analyzed. The diagnostic accuracy rates of histology in the M and F needle groups were 89.2% and 88.8%, respectively (p=1.00).
Conclusions
Both the needles showed high diagnostic yield, and no significant difference in performance was observed between the two.

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Case Report
Endoscopic Ultrasound Through-the-Needle Biopsy for the Diagnosis of an Abdominal Bronchogenic Cyst
Jessica Cassiani, Stefano Francesco Crinò, Erminia Manfrin, Matteo Rivelli, Armando Gabbrielli, Alfredo Guglielmi, Corrado Pedrazzani
Clin Endosc 2021;54(5):767-770.   Published online February 17, 2021
DOI: https://doi.org/10.5946/ce.2020.195
AbstractAbstract PDFPubReaderePub
A 57-year-old woman with epigastric pain was diagnosed with a 6-cm abdominal cystic lesion of unclear origin on cross-sectional imaging. Endoscopic ultrasound (EUS) demonstrated a unilocular cyst located between the pancreas, gastric wall, and left adrenal gland, with a regular wall filled with dense fluid with multiple hyperechoic floating spots. A 19-G needle was used to puncture the cyst, but no fluid could be aspirated. Therefore, EUS-guided through-the-needle biopsy (EUS-TTNB) was performed. Histological analysis of the retrieved fragments revealed a fibrous wall lined by “respiratory-type” epithelium with ciliated columnar cells, consistent with the diagnosis of a bronchogenic cyst. Laparoscopic excision was performed, and the diagnosis was confirmed based on the findings of the surgical specimen. Abdominal bronchogenic cysts are extremely uncommon, and a definitive diagnosis is commonly obtained after the examination of surgical specimens due to the lack of pathognomonic findings on cross-sectional imaging and poor cellularity on EUS-guided fine-needle aspiration cytology. EUS-TTNB is useful for establishing a preoperative histological diagnosis, thus supporting the decision-making process.

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    Jiao Jiao, Xiaofei Fan, Lili Luo, Zhongqing Zheng, Bangmao Wang, Wentian Liu
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Original Articles
Superior Specimen and Diagnostic Accuracy with Endoscopic Ultrasound-Guided Liver Biopsies Using 19-Gauge versus 22-Gauge Core Needles
Rucha M. Shah, Jason Schmidt, Elizabeth John, Sheila Rastegari, Priyanka Acharya, Prashant Kedia
Clin Endosc 2021;54(5):739-744.   Published online November 13, 2020
DOI: https://doi.org/10.5946/ce.2020.212
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound-guided liver biopsy (EUS-LB) is an effective and safe method of procuring liver tissue. The aims of this study were to assess and compare the outcomes and tissue adequacy of a single-pass, single-actuation, wet suction technique between 19 G and 22 G needles in patients undergoing EUS-LB.
Methods
We performed a prospective case series study of 20 patients undergoing EUS-LB at a single center between September 2017 and April 2020. The primary objective was to evaluate differences in sample adequacy via a single actuation wet suction technique between a 19 G core needle and a 22 G core needle. Adequacy was gauged by cumulative core biopsy length and the number of portal tracts visualized.
Results
The 19 G needle provided a longer core length (2.5 cm vs. 1.2 cm, p<0.0001), more complete portal tracts (5.8 vs. 1.7, p<0.0001), more total tracts (8.8 vs. 3, p<0.0001), and a longer, intact, fragment length (0.75 cm vs. 0.32 cm, p<0.0006). The 19 G needle was superior in providing adequate (60% vs. 5%, p<0.001) and diagnostic pathologic samples (85% vs. 10%, p<0.001).
Conclusions
A single-pass, single-actuation, wet suction technique using a 19 G needle is superior to that using a 22 G needle for tissue acquisition and sample adequacy in EUS-LB.

Citations

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Endoscopic Ultrasound-Guided, Percutaneous, and Transjugular Liver Biopsy: A Comparative Systematic Review and Meta-Analysis
Thomas R. McCarty, Ahmad Najdat Bazarbashi, Basile Njei, Marvin Ryou, Harry R. Aslanian, Thiruvengadam Muniraj
Clin Endosc 2020;53(5):583-593.   Published online September 29, 2020
DOI: https://doi.org/10.5946/ce.2019.211
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Percutaneous liver biopsy (PCLB) or transjugular liver biopsy (TJLB) have traditionally been performed to obtain a sample of hepatic tissue; however, endoscopic ultrasound-guided liver biopsy (EUSLB) has become an attractive alternative. The aim of this study was to compare the efficacy and safety of EUSLB, PCLB, and TJLB.
Methods
Search strategies were developed in accordance with PRISMA and MOOSE guidelines. Major outcomes included the following: adequacy of biopsy specimens (i.e., complete portal triads [CPT], total specimen length [TSL] in mm, and length of longest piece [LLP]) in mm), and rate of adverse events. Only studies comparing all biopsy approaches (i.e., EUSLB, PCLB, and TJLB) were included.
Results
Five studies (EUSLB [n=301]; PCLB [n=176]; and TJLB [n=179]) were included. Biopsy cumulative adequacy rates for EUSLB, PCLB, and TJLB were 93.51%, 98.27%, and 97.61%, respectively. Based on the subgroup analysis limited to EUS biopsy needles in current clinical practice, there was no difference in biopsy adequacy or adverse events for EUSLB compared to PCLB and TJLB (all p>0.050). A comparison of EUSLB and PCLB revealed no difference between specimens regarding both CPT (p=0.079) and LLP (p=0.085); however, a longer TSL (p<0.001) was observed. Compared to TJLB, EUSLB showed no difference in LLP (p=0.351), fewer CPT (p=0.042), and longer TSL (p=0.005).
Conclusions
EUSLB appears to be a safe, minimally invasive procedure that is comparable to PCLB and TJLB regarding biopsy specimens obtained and rate of adverse events associated with each method.

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Endoscopic Ultrasound-Guided Fine Needle Biopsy Needles Provide Higher Diagnostic Yield Compared to Endoscopic Ultrasound-Guided Fine Needle Aspiration Needles When Sampling Solid Pancreatic Lesions: A Meta-Analysis
Benjamin D. Renelus, Daniel S. Jamorabo, Iman Boston, William M. Briggs, John M. Poneros
Clin Endosc 2021;54(2):261-268.   Published online August 31, 2020
DOI: https://doi.org/10.5946/ce.2020.101
AbstractAbstract PDFPubReaderePub
Background
/Aims: Studies comparing the utility of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for solid pancreatic lesions have been inconclusive with no clear superiority. The aim of this meta-analysis was to compare the diagnostic accuracy and safety between the two sampling techniques.
Methods
We performed a systematic search of randomized controlled trials published between 2012 and 2019. The primary outcome was overall diagnostic accuracy. Secondary outcomes included adverse event rates, cytopathologic and histopathologic accuracy, and the mean number of passes required to obtain adequate tissue between FNA and FNB needles. Fixed and random effect models with pooled estimates of target outcomes were developed.
Results
Eleven studies involving 1,365 participants were included for analysis. When compared to FNB, FNA had a significant reduction in diagnostic accuracy (81% and 87%, p=0.005). In addition, FNA provided reduced cytopathologic accuracy (82% and 89%, p=0.04) and an increased number of mean passes required compared to FNB (2.3 and 1.6, respectively, p<0.0001). There was no difference in adverse event rate between FNA and FNB needles (1.8% and 2.3% respectively, p=0.64).
Conclusions
FNB provides superior diagnostic accuracy without compromising safety when compared to FNA. FNB should be readily considered by endosonographers when evaluating solid pancreatic masses.

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Reasons for Diagnostic Failure in Forty-Five Consecutive Mucosal Cutting Biopsy Examinations of Gastric Subepithelial Tumors
Yoshiko Nakano, Toshitatsu Takao, Yoshinori Morita, Shinwa Tanaka, Takashi Toyonaga, Eiji Umegaki, Yuzo Kodama
Clin Endosc 2020;53(5):575-582.   Published online February 14, 2020
DOI: https://doi.org/10.5946/ce.2019.150
AbstractAbstract PDFPubReaderePub
Background
/Aims: Mucosal cutting biopsy (MCB) is useful for the histopathological diagnosis of gastric subepithelial tumors (SETs). However, there is little information on cases in which MCB did not establish a diagnosis. In the current study, we aimed to investigate the characteristics of cases in which MCB was unsuccessful.
Methods
Cases in which MCB was used to histopathologically diagnose gastric SETs at Kobe University Hospital between August 2012 and October 2018 were retrospectively reviewed.
Results
Forty-five cases in which MCB was used to diagnose 43 gastric SETs in 43 patients were analyzed. The median tumor size was 20 mm (range, 8–50 mm). Pathological examinations resulted in definitive and suspected diagnoses and no diagnosis in 29 (gastrointestinal stromal tumor: n=17, leiomyoma: n=7, aberrant pancreas: n=3, others: n=2), 6, and 10 cases, respectively. Failure to expose the tumor according to retrospective examinations of endoscopic images was significantly associated with no diagnosis. Other possible explanations included a less elevated tumor, biopsy of the surrounding field instead of the tumor due to the mobility, and poor endoscope maneuverability due to the tumor being close to the cardia.
Conclusions
Clear exposure of gastric SETs during MCB may improve the diagnostic rate of such examinations.

Citations

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  • Endoscopic Diagnosis of Gastric Subepithelial Lesions < 20 mm: Current Strategies and Emerging Solutions
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Modified Endoscopic Ultrasound Needle to Obtain Histological Core Tissue Samples: A Retrospective Analysis
Munish Ashat, Kaartik Soota, Jagpal S. Klair, Sarika Gupta, Chris Jensen, Arvind R. Murali, Randhir Jesudoss, Rami El-Abiad, Henning Gerke
Clin Endosc 2020;53(4):471-479.   Published online February 5, 2020
DOI: https://doi.org/10.5946/ce.2019.108
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound (EUS)-guided fine-needle aspiration is very effective for providing specimens for cytological evaluation. However, the ability to provide sufficient tissue for histological evaluation has been challenging due to the technical limitations of dedicated core biopsy needles. Recently, a modified EUS needle has been introduced to obtain tissue core samples for histological analysis. We aimed to determine (1) its ability to obtain specimens for histological assessment and (2) the diagnostic accuracy of EUS-guided fine-needle biopsy (EUS-FNB) using this needle.
Methods
We retrospectively analyzed consecutive cases of FNB using modified EUS needles for 342 lesions in 303 patients. The cytology and histological specimens were analyzed. Diagnostic accuracy was calculated.
Results
Adequate cytological and histological assessment was possible in 293/342 (86%) and 264/342 (77%) lesions, respectively. Diagnostic accuracy of the cytological specimen was 294/342 (86%) versus 254/342 (74%) for the histological specimen (p<0.01). Diagnostic accuracy of the combined cytological and histological assessment was 323/342 (94.4%), which was significantly higher than that of both histology alone (p<0.001) and cytology alone (p=0.001).
Conclusions
EUS-FNB with the modified EUS needle provided histologic tissue cores in the majority of cases and achieved excellent diagnostic accuracy with few needle passes.

Citations

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    BMC Gastroenterology.2023;[Epub]     CrossRef
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    Gastrointestinal Endoscopy.2021; 93(1): 140.     CrossRef
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Endoscopic Ultrasound Fine-Needle Aspiration versus Fine-Needle Biopsy for Lymph Node Diagnosis: A Large Multicenter Comparative Analysis
Diogo Turiani Hourneaux de Moura, Thomas R. McCarty, Pichamol Jirapinyo, Igor Braga Ribeiro, Galileu Ferreira Ayala Farias, Marvin Ryou, Linda S. Lee, Christopher C. Thompson
Clin Endosc 2020;53(5):600-610.   Published online December 3, 2019
DOI: https://doi.org/10.5946/ce.2019.170
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is preferred for sampling of lymph nodes (LNs) adjacent to the gastrointestinal wall; however, fine-needle biopsy (FNB) may provide improved diagnostic outcomes. This study aimed to evaluate the comparative efficacy and safety of FNA versus FNB for LN sampling.
Methods
This was a multicenter retrospective study of prospectively collected data to evaluate outcomes of EUS-FNA and EUS-FNB for LN sampling. Characteristics analyzed included sensitivity, specificity, accuracy, the number of needle passes, diagnostic adequacy of rapid on-site evaluation (ROSE), cell-block analysis, and adverse events.
Results
A total of 209 patients underwent EUS-guided LN sampling. The mean lesion size was 16.22±8.03 mm, with similar sensitivity and accuracy between FNA and FNB ([67.21% vs. 75.00%, respectively, p=0.216] and [78.80% vs. 83.17%, respectively, p=0.423]). The specificity of FNB was better than that of FNA (100.00% vs. 93.62%, p=0.01). The number of passes required for diagnosis was not different. Abdominal and peri-hepatic LN location demonstrated FNB to have a higher sensitivity (81.08% vs. 64.71%, p=0.031 and 80.95% vs. 58.33%, p=0.023) and accuracy (88.14% vs. 75.29%, p=0.053 and 88.89% vs. 70.49%, p=0.038), respectively. ROSE was a significant predictor for accuracy (odds ratio, 5.16; 95% confidence interval, 1.15–23.08; p=0.032). No adverse events were reported in either cohort.
Conclusions
Both EUS-FNA and EUS-FNB are safe for the diagnosis of LNs. EUS-FNB is preferred for abdominal LN sampling. EUSFNA+ ROSE was similar to EUS-FNB alone, showing better diagnosis for EUS-FNB than traditional FNA. While ROSE remained a significant predictor for accuracy, due to its poor availability in most centers, its use may be limited to cases with previous inconclusive diagnoses.

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    Mateus Pereira Funari, Igor Braga Ribeiro, Marcos Eduardo Lera dos Santos, Sergio Eiji Matuguma, Eduardo Guimarães Hourneaux de Moura
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Focused review series
Present and Future of Endoscopic Ultrasound-Guided Tissue Acquisition in Solid Pancreatic Tumors
Jae Keun Park, Kwang Hyuck Lee
Clin Endosc 2019;52(6):541-548.   Published online November 29, 2019
DOI: https://doi.org/10.5946/ce.2019.127
AbstractAbstract PDFPubReaderePub
Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is a well-established method for pathological diagnosis of solid pancreatic neoplasm. It can be performed either as EUS-guided fine-needle aspiration (EUS-FNA) or EUS-guided fine-needle biopsy (EUSFNB). The incidence of adverse events related to EUS-TA is less than 1%. The factors that affect the diagnostic accuracy and specimen adequacy include the techniques used, type and size of the needle, competency of endosonographers, presence of cytopathologists/ cytotechnologists, and rapid on-site examination. EUS-TA may contribute to precision medicine through obtaining tissue samples for next-generation sequencing. The current status, several clinical issues for diagnostic yield and adverse events, and future perspectives of EUS-FNA/FNB for diagnosing pancreatic neoplasm have been discussed in this review article.

Citations

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  • A Novel Diagnostic Model of Biomarkers in the Washing Fluid Obtained by EUS-FNA in Pancreatic Cancer
    Chen-Fan Li, Lan-Xiang Hao, Yi-Jia Chen, En-De Lin, Chun-Ping Zhang, Li-Hua Wu, Xu-Ying Liao, Jia-Li Zhou, Jian-Hui Zhu, Ling-Hui Zhan, Xian-Ming Liang, Yi-Qun Hu
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  • Diagnostic performance of EUS-guided tissue acquisition for solid pancreatic lesions ≤10 mm
    Yuki Kawasaki, Susumu Hijioka, Yoshikuni Nagashio, Akihiro Ohba, Yuta Maruki, Kotaro Takeshita, Tetsuro Takasaki, Daiki Agarie, Yuya Hagiwara, Hidenobu Hara, Kohei Okamoto, Daiki Yamashige, Shunsuke Kondo, Chigusa Morizane, Hideki Ueno, Takahiro Mizui, Ta
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  • A combination of faecal and intratumour microbial community profiling reveals novel diagnostic and prognostic biomarkers for pancreatic tumours
    Wei Wang, Cheng Qian, Ting Wang, Yuetong Jiang, Yiran Zhou, Kaiyu Liu, Zhiyang Ma, Pengyi Liu, Yichi Wu, Leying Chen, Huaizhi Wang, Tingting Zhou
    Clinical and Translational Medicine.2024;[Epub]     CrossRef
  • Molecular Characterization and Xenotransplantation of Pancreatic Cancer Using Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA)
    Lilia Antonova, Piriya Paramanthan, Theresa Falls, Marie-Eve Wedge, Justin Mayer, Harman S. Sekhon, John McPherson, Robert E. Denroche, Steven Gallinger, John Cameron Bell, Carolina S. Ilkow, Avijit Chatterjee
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    Takuya Okamoto, Shuhei Shintani, Hiromitsu Maehira, Kosuke Hiroe, Shiori Onoda, Hidenori Kimura, Atsushi Nishida, Masaji Tani, Ryoji Kushima, Osamu Inatomi
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    Nam Hee Kim, Hong Joo Kim
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    培君 任
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  • 7,543 View
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Case Reports
An Unusual Presentation of a Solid Pseudopapillary Tumor of the Pancreas Mimicking Adenocarcinoma
Hyung Ku Chon, Keum Ha Choi, Tae Hyeon Kim
Clin Endosc 2020;53(5):615-619.   Published online November 22, 2019
DOI: https://doi.org/10.5946/ce.2019.158
AbstractAbstract PDFPubReaderePub
Solid pseudopapillary tumors of the pancreas are rare and typically occur in young women. Compared with pancreatic adenocarcinoma, solid pseudopapillary tumors are characterized by notable indolent biological behavior associated with a favorable prognosis. Despite their large size, these tumors rarely metastasize. Even in cases of hepatic metastasis, most lesions are usually solitary in distribution and are amenable to resection. We report a case of a 55-year-old man with a small solid pseudopapillary tumor (≤3-cm diameter) mimicking a pancreatic adenocarcinoma, with multiple hepatic metastases. The diagnosis was confirmed by endoscopic ultrasound-guided fine-needle biopsy using a 22-G core needle. Unfortunately, rapid tumor progression led to patient mortality 5 months after diagnosis. To our knowledge, this is the first case report that describes a small solid pseudopapillary tumor of the pancreas with multiple hepatic metastasis and poor prognosis in a patient who was diagnosed with this condition at the time of initial diagnosis.

Citations

Citations to this article as recorded by  
  • Solid pseudopapillary neoplasm of the pancreas in an adolescent: A case report and review of the literature
    Aakriti Sapkota, Rajesh Paudel, Sandip Pandey, Navin Bhatt
    World Journal of Gastrointestinal Oncology.2025;[Epub]     CrossRef
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    Chi-Chi Chen, Ting-Yuan Feng, Hsiang-Chun Jan, Shaw-Jiun Chou, Tzu-Hung Chen, Sheng-Chun Wang
    International Journal of Surgery Case Reports.2024; 120: 109867.     CrossRef
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    Thara Pratap, Dhanya Jacob, Abhishek Yadav, Muhammed Jasim Abdul Jalal, Iona Leekha Mathew
    Journal of Gastrointestinal and Abdominal Radiology.2022; 05(03): 196.     CrossRef
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    D.V. Sidorov, N.A. Grishin, M.V. Lozhkin, N.N. Volchenko, Kh.S. Kosumova, A.A. Troitskii, I.V. Stepanyuk, S.A. Bykasov, R.I. Moshurov
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  • 6,684 View
  • 154 Download
  • 4 Web of Science
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Submucosal Tunneling Muscle Biopsy for Esophageal Motility Disorders: A Case Report
Aleksandr A. Smirnov, Maya M. Kiriltseva, Aleksandr N. Burakov, Maksim V. Maksimov, Anna V. Botina, Marina M. Saadulaeva, Nadezda V. Konkina
Clin Endosc 2020;53(3):370-373.   Published online August 20, 2019
DOI: https://doi.org/10.5946/ce.2019.109
AbstractAbstract PDFPubReaderePub
Submucosal tunneling endoscopic technique can be useful in obtaining esophageal muscle specimens in patients with esophageal motility disorders. Here, we describe the case of a patient with systemic sclerosis. Histological verification of the esophageal involvement in the pathological process was required for the treatment. There were no intra- and post- operational complications.

Citations

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  • Gastrointestinal histology of systemic sclerosis: A systematic review
    Aidan K. Strother, Robert M. Anderton, Naveen Kalavar, Ali Y. Ayla, Tracy Ashby, Amanda Mayer, Roshan Dongre, Francesco Bonomi, Silvia Bellando Randone, Michael Hughes, Zsuzsanna H. McMahan
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    Tadateru Maehata, Yoshinori Sato, Yusuke Nakamoto, Masaki Kato, Akiyo Kawashima, Hirofumi Kiyokawa, Hiroshi Yasuda, Hiroyuki Yamamoto, Keisuke Tateishi
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  • 6,341 View
  • 95 Download
  • 2 Web of Science
  • 2 Crossref
Close layer
Original Articles
Endoscopic Ultrasound-Guided Liver Biopsy Using a Core Needle for Hepatic Solid Mass
Hyung Ku Chon, Hee Chan Yang, Keum Ha Choi, Tae Hyeon Kim
Clin Endosc 2019;52(4):340-346.   Published online July 15, 2019
DOI: https://doi.org/10.5946/ce.2018.175
AbstractAbstract PDFPubReaderePub
Background
/Aims: This study aimed to evaluate the feasibility and efficacy of endoscopic ultrasound-guided fine needle biopsy (EUSFNB) using a core needle for hepatic solid masses (HSMs). Additionally, the study aimed to assess factors that influence the diagnostic accuracy of EUS-FNB for HSMs.
Methods
A retrospective analysis of patients who underwent EUS-FNB for the pathological diagnosis of HSMs was conducted between January 2013 and July 2017. The procedure had been performed using core needles of different calibers. The assessed variables were mass size, puncture route, needle type, and the number of needle passes.
Results
Fifty-eight patients underwent EUS-FNB for the pathologic evaluation of HSMs with a mean mass size of 21.4±9.2 mm. EUSFNB was performed with either a 20-G (n=14), 22-G (n=29) or a 25-G core needle (n=15). The diagnostic accuracy for this procedure was 89.7%, but both specimen adequacy for histology and available immunohistochemistry stain were 91.4%. The sensitivity and specificity of EUS-FNB were 89.7% and 100%, respectively. There was one case involving bleeding as a complication, which was controlled with endoscopic hemostasis. According to the multivariate analysis, no variable was independently associated with a correct final diagnosis.
Conclusions
EUS-FNB with core biopsy needle is a safe and highly accurate diagnostic option for assessing HSMs. There were no variable factors associated with diagnostic accuracy.

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Comparison of Endoscopic Ultrasound Biopsy Needles for Endoscopic Ultrasound-Guided Liver Biopsy
Armen Eskandari, Patrick Koo, Heejung Bang, Dorina Gui, Shiro Urayama
Clin Endosc 2019;52(4):347-352.   Published online July 10, 2019
DOI: https://doi.org/10.5946/ce.2019.005
AbstractAbstract PDFPubReaderePub
Background
/Aims: To compare the performance of latest commercially available endoscopic ultrasound biopsy needles.
Methods
Six latest commercially available needles were tested on a freshly harvested bovine liver; the tested needles included three 19 G, one 20 G, and two 22 G needles. Five biopsies were performed per needle with 10 mL of wet suction. The primary outcome was the number of complete portal tracts (CPTs) per needle aspirate. The secondary outcomes were the mean specimen length and mean fragment length. Analysis of variance and Tukey’s test were applied.
Results
All 19 G needles and the 20 G needle yielded similar mean CPTs and were superior to the SharkCore 22 G needle (p<0.001 adjusted for multiplicity). There was no statistically significant difference in total specimen length among the three 19 G needles and the 20 G needle tested. The two 22 G needles performed similarly with respect to the number of CPTs, mean fragment length, and mean specimen length (adjusted p=0.07, p=0.59, and p=0.10, respectively).
Conclusions
The specimen adequacy was similar among the 3 latest commercially available 19 G needles. The endoscopist may choose a larger-bore needle based on availability without concerns of specimen adequacy. Further studies are needed to assess the ease of needle use in various anatomical locations and to confirm the optimal needle design.

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Prospective Assessment of the Performance of a New Fine Needle Biopsy Device for EUS-Guided Sampling of Solid Lesions
Ihab I. El Hajj, Howard Wu, Sarah Reuss, Melissa Randolph, Akeem Harris, Mark A. Gromski, Mohammad Al-Haddad
Clin Endosc 2018;51(6):576-583.   Published online July 13, 2018
DOI: https://doi.org/10.5946/ce.2018.053
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) remains the most common EUS-guided tissue acquisition technique. This study aimed to evaluate the performance of a new Franseen tip fine needle biopsy (FNB) device for EUSguided sampling of solid lesions and compare it with the historical FNA technique.
Methods
Acquire® 22 G FNB needle (Boston Scientific Co., Natick, MA, USA) was used for solid tumor sampling (Study group). Tissue was collected for rapid on-site evaluation, and touch and crush preparations were made. Historical EUS-FNA samples obtained using Expect® 22 G FNA needle (Boston Scientific Co.) were used as controls (Control group). All specimens were independently evaluated by two cytopathologists blinded to the formal cytopathological diagnosis.
Results
Mean cell block histology scores were significantly higher (p=0.046) in the FNB group (51 samples) despite a significantly lower (p<0.001) mean number of passes compared to the FNA group (50 specimens). The overall diagnostic yields for the FNB vs. FNA groups were 96% vs. 88%. The degree of tumor differentiation was adequately assessed in all cell block qualifying lesions in the FNB group. Two patients developed post-FNB abdominal pain.
Conclusions
The new Franseen tip FNB device provides histologically superior and cytologically comparable specimens to those obtained by FNA, but with fewer passes.

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Mucosal Incision and Forceps Biopsy for Reliable Tissue Sampling of Gastric Subepithelial Tumors
Sa Young Shin, Sang Jin Lee, Jae Hyuck Jun, Jong Kyu Park, Hyun Il Seo, Koon Hee Han, Young Don Kim, Woo Jin Jeong, Gab Jin Cheon
Clin Endosc 2017;50(1):64-68.   Published online March 4, 2016
DOI: https://doi.org/10.5946/ce.2015.094
AbstractAbstract PDFPubReaderePub
Background
/Aims: The diagnostic efficacy of current tissue sampling techniques for gastric subepithelial tumors (SETs) is limited. Better tissue sampling techniques are needed to improve pathological diagnosis. The aim of this study was to evaluate the safety and efficacy of a new technique, mucosal incision and forceps biopsy, for reliable tissue sampling of gastric SETs.
Methods
This study enrolled 12 consecutive patients who underwent mucosal incision and forceps biopsy of gastric SETs between November 2011 and September 2014 at Gangneung Asan Hospital. The medical records of patients were reviewed retrospectively. The safety and diagnostic yield of this method were evaluated.
Results
By performing mucosal incision and forceps biopsy, we were able to provide a definitive histological diagnosis for 11 out of 12 cases. The pathological diagnoses were leiomyoma (3/11), gastrointestinal stromal tumor (GIST; 2/11), lipoma (2/11), schwannoma (1/11), and ectopic pancreas (3/11). In cases of leiomyoma (n=3) and GIST (n=2), tissue samples were of sufficient size to allow immunohistochemical staining. In addition, the mitotic index was evaluated in two cases of GIST. There were no procedure-related complications.
Conclusions
Mucosal incision and forceps biopsy can be used as one of several methods to obtain adequate tissue samples from gastric SETs.

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Yields and Utility of Endoscopic Ultrasonography-Guided 19-Gauge Trucut Biopsy versus 22-Gauge Fine Needle Aspiration for Diagnosing Gastric Subepithelial Tumors
Hee Kyong Na, Jeong Hoon Lee, Young Soo Park, Ji Yong Ahn, Kwi-Sook Choi, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung, Jin-Ho Kim
Clin Endosc 2015;48(2):152-157.   Published online March 27, 2015
DOI: https://doi.org/10.5946/ce.2015.48.2.152
AbstractAbstract PDFPubReaderePub
Background/Aims

To evaluate the yields and utility of 19-gauge (G) Trucut biopsy (TCB) versus 22 G fine needle aspiration (FNA) for diagnosing gastric subepithelial tumors (SETs).

Methods

We retrieved data for 152 patients with a gastric SET larger than 2 cm who had undergone endoscopic ultrasonography (EUS)-guided 19 G TCB (n=90) or 22 G FNA (n=62). Relevant clinical, tumor-specific, and EUS procedural information was reviewed retrospectively.

Results

A specific diagnosis was made for 76 gastrointestinal stromal tumors (GISTs) and 51 non-GIST SETs. The diagnostic yield of TCB was greater than that of FNA (77.8% vs. 38.7%, p<0.001). The percentage of non-diagnostic specimens (suspicious and insufficient) was significantly lower in the TCB group (6.7% and 15.5%, respectively) than in the FNA group (22.6% and 38.7%, respectively; both p<0.001). TCB accurately diagnosed 90.9% of GISTs and 81.1% of non-GIST SETs, whereas FNA accurately diagnosed 68.8% of GISTs and 14.3% of non-GIST SETs. There were nine technical failures with TCB, and the rate of adverse events did not differ between the groups (TCB vs. FNA, 3.3% vs. 8.1%; p=0.27).

Conclusions

Nineteen-gauge TCB is safe and highly valuable for diagnosing gastric SETs larger than 2 cm if technical failure can be avoided.

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Case Reports
Primary Fallopian Tube Carcinoma Diagnosed with Endoscopic Ultrasound Elastography with Fine Needle Biopsy
Eui Bae Kim, Tae Hee Lee, Jeong Sig Kim, In Ho Choi
Clin Endosc 2014;47(5):464-468.   Published online September 30, 2014
DOI: https://doi.org/10.5946/ce.2014.47.5.464
AbstractAbstract PDFPubReaderePub

Primary fallopian tube carcinoma (PFTC) is a rare gynecological cancer that is very difficult to diagnose preoperatively. Here, we report the case of a 66-year-old female patient with PFTC that was diagnosed preoperatively on the basis of the characteristic features on endoscopic ultrasound (EUS) elastography and fine needle biopsy (FNB). EUS showed a sausage-shaped hypoechoic mass, 8 cm in size, with irregular margins and heterogeneous internal echoes extending to both adnexa. EUS elastography revealed that the mass had a blue color pattern, representing hard stiffness, and a heterogeneous green/red color pattern distributed outside the tumor, representing intermediate stiffness. Histopathologic analysis of the FNB and operative specimens confirmed the diagnosis of fallopian tube carcinoma. This is the first reported case of a combined EUS elastography and FNB of an adnexal mass leading to a preoperative diagnosis of fallopian tube carcinoma.

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  • The clinical impact of ultrasound contrast agents in EUS: a systematic review according to the levels of evidence
    Pietro Fusaroli, Bertrand Napoleon, Rodica Gincul, Christine Lefort, Laurent Palazzo, Maxime Palazzo, Masayuki Kitano, Kosuke Minaga, Giancarlo Caletti, Andrea Lisotti
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Endoscopic Ultrasound-Guided Sampling of a Metastatic Mucinous Adenocarcinoma Mimicking a Gastric Subepithelial Tumor
Dae Chul Seo, Tae Hee Lee, Yoon Mi Jeen, Hyun Gun Kim, Eui Bae Kim, Sang Cheol Lee
Clin Endosc 2014;47(5):460-463.   Published online September 30, 2014
DOI: https://doi.org/10.5946/ce.2014.47.5.460
AbstractAbstract PDFPubReaderePub

Metastatic mucinous adenocarcinoma of appendix origin and mimicking a gastric subepithelial tumor (SET) is very rare. Endoscopic ultrasound (EUS)-guided sampling is a useful diagnostic method for SETs. However, the cytologic findings of metastatic mucinous adenocarcinoma are unfamiliar to many pathologists and gastroenterologists. These findings present a diagnostic challenge because the introduction of gastric epithelium and mucin into the specimen during the procedure can be misleading. This is the first reported experience of an EUS-guided sampling of a gastric SET in a patient with suspected appendiceal tumor, to make the diagnosis of a mucinous adenocarcinoma.

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  • A Case of Transduodenal Endoscopic Ultrasound-Guided Biopsy of an Appendiceal Lesion
    Nihal Ijaz Khan, Abdullah Abbasi, Saurabh Chandan, Sagar Pathak, Charanjeet Singh, Muhammad K. Hasan
    ACG Case Reports Journal.2024; 11(12): e01574.     CrossRef
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Reviews
Fine-Needle Biopsy: Should This Be the First Choice in Endoscopic Ultrasound-Guided Tissue Acquisition?
Eun Young Kim
Clin Endosc 2014;47(5):425-428.   Published online September 30, 2014
DOI: https://doi.org/10.5946/ce.2014.47.5.425
AbstractAbstract PDFPubReaderePub

Endoscopic ultrasound (EUS)-guided tissue acquisition is an indispensable technique for the diagnosis of many diseases of the gastrointestinal tract and adjacent structures. EUS-guided fine-needle aspiration (EUS-FNA) is known for its high accuracy and low complication rate. However, the outcome of EUS-FNA highly depends on several factors such as the location and characteristics of the lesion, endosonographer's experience, technique of sampling and sample preparation, type and size of the needle used, and presence of a cytopathologist for rapid on-site examination. EUS-guided fine-needle biopsy is useful to obtain core tissue samples with relatively fewer passes. Aspiration of core tissue with preserved architecture is beneficial for the diagnosis of certain diseases and the performance of ancillary testing such as tumor molecular profiling. Issues related to needle size, type, and their acquired samples for cytologic and histologic evaluation are discussed here.

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    Eun Jeong Gong, Kee Don Choi
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    Eun Young Kim
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    Eun Young Kim, Kwang An Kwon, Il Ju Choi, Ji Kon Ryu, Ki Baik Hahm
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Neoplasia in Chronic Pancreatitis: How to Maximize the Yield of Endoscopic Ultrasound-Guided Fine Needle Aspiration
Ji Young Bang, Shyam Varadarajulu
Clin Endosc 2014;47(5):420-424.   Published online September 30, 2014
DOI: https://doi.org/10.5946/ce.2014.47.5.420
AbstractAbstract PDFPubReaderePub

When performing endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), identifying neoplasia in the setting of chronic pancreatitis can be technically challenging. The morphology of an ill-defined mass on sonography, presence of calcifications or intervening collaterals, reverberation from a biliary stent, low yield of tissue procurement, and interpretative errors in cytopathology can result in both false-negative and false-positive results. Although these challenges cannot be completely eliminated, elastography or contrast-enhanced imaging can aid in differentiating an inflammatory mass from a neoplasm. Also, performing more passes of FNA, procuring core biopsy material, performing rapid onsite evaluation, conducting ancillary pathology studies, and even repeating the procedure on a different day can aid in improving the diagnostic performance of EUS-FNA. This review provides a concise update and offers practical tips to improving the diagnostic yield of EUS-FNA when sampling solid pancreatic mass lesions in the setting of chronic pancreatitis.

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    Utpal Mondal, Nichole Henkes, Sandeep Patel, Laura Rosenkranz
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Case Report
Primary Papillary Thyroid Carcinoma Diagnosed by Using Endoscopic Ultrasound with Fine Needle Aspiration
Ala Abdel Jalil, Fateh A. Elkhatib, Abdulah A. Mahayni, Amer A. Alkhatib
Clin Endosc 2014;47(4):350-352.   Published online July 28, 2014
DOI: https://doi.org/10.5946/ce.2014.47.4.350
AbstractAbstract PDFPubReaderePub

There is paucity in the literature on the use of endoscopic ultrasound (EUS) for evaluating the thyroid gland. We report the first case of primary papillary thyroid cancer diagnosed by using EUS and fine needle aspiration (FNA). A 66-year-old man underwent EUS for the evaluation of mediastinal lymphadenopathy. FNA of the lymph nodes showed benign findings. A hypoechoic mass was noted in the right lobe of the thyroid gland. Therefore, FNA was performed. The cytological results were consistent with primary papillary thyroid cancer.

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  • EUS of the neck: A comprehensive anatomical reference for the staging of head and neck cancer (with videos)
    Malay Sharma, Amit Pathak, Abid Shoukat, ChittapuramSrinivasan Rameshbabu, Sumit Goyal, Raghav Bansal, Rooby Hamza, Kshitij Charaya
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  • 41 Download
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  • 1 Crossref
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Original Article
Addition of Endoscopic Ultrasound (EUS)-Guided Fine Needle Aspiration and On-Site Cytology to EUS-Guided Fine Needle Biopsy Increases Procedure Time but Not Diagnostic Accuracy
Rajesh N. Keswani, Kumar Krishnan, Sachin Wani, Laurie Keefer, Srinadh Komanduri
Clin Endosc 2014;47(3):242-247.   Published online May 31, 2014
DOI: https://doi.org/10.5946/ce.2014.47.3.242
AbstractAbstract PDFPubReaderePub
Background/Aims

Although the diagnostic accuracy of endoscopic ultrasound with fine needle aspiration (EUS-FNA) in pancreas adenocarcinoma is high, endoscopic ultrasound with fine needle biopsy (EUS-FNB) is often required in other lesions; in these cases, it may be possible to forgo initial EUS-FNA and rapid on-site cytology evaluation (ROSE). The aim of this study was to compare the diagnostic accuracy of EUS-FNB alone (EUS-FNB group) with a conventional sampling algorithm of EUS-FNA with ROSE followed by EUS-FNB (EUS-FNA/B group) in nonpancreas adenocarcinoma lesions.

Methods

Retrospective cohort study of subjects who underwent EUS sampling of nonpancreatic adenocarcinoma lesions between February 2011 and May 2013.

Results

Over the study period, there were 43 lesions biopsied in 41 unique patients in the EUS-FNB group and 53 patients in the EUS-FNA/B group. Overall diagnostic accuracy was similar between the EUS-FNB and EUS-FNA/B groups (83.7% vs. 84.9%; p=1.0). In the subgroup of subepithelial mass lesions, diagnostic accuracy remained similar in the EUS-FNB and EUS-FNA/B groups (81.0% and 70.6%; p=0.7). EUS-FNB procedures were significantly shorter than those in the EUS-FNA/B group (58.4 minutes vs. 73.5 minutes; p<0.0001).

Conclusions

EUS-FNB without on-site cytology provides a high diagnostic accuracy in nonpancreas adenocarcinoma lesions. There appears to be no additive benefit with initial EUS-FNA but this requires further study in a prospective study.

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  • AGA White Paper: Optimizing Endoscopic Ultrasound–Guided Tissue Acquisition and Future Directions
    Sachin Wani, V. Raman Muthusamy, Cindy M. McGrath, Antonia R. Sepulveda, Ananya Das, Wells Messersmith, Michael L. Kochman, Janak Shah
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Case Reports
Extramedullary Plasmacytoma of the Pancreas Diagnosed Using Endoscopic Ultrasonography-Guided Fine Needle Aspiration
Young Hoon Roh, Sang Youn Hwang, Seon-Mi Lee, Jung Woo Im, Joon Suk Kim, Kyeong A Kwon, Joo Yeon Song, Soo Yeong Jeong
Clin Endosc 2014;47(1):115-118.   Published online January 24, 2014
DOI: https://doi.org/10.5946/ce.2014.47.1.115
AbstractAbstract PDFPubReaderePub

Extramedullary plasmacytoma involves organs outside the bone marrow; however, involvement of the pancreas is rare. We recently experienced a case of extramedullary plasmacytoma of the pancreas that was diagnosed by endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA). EUS-FNA, which has a high diagnostic accuracy and an excellent safety profile, is the modality of choice for establishing tissue diagnosis. We report a case of extramedullary plasmacytoma of the pancreas diagnosed using EUS-FNA.

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Retroperitoneal Cystic Lymphangioma Diagnosed by Endoscopic Ultrasound-Guided Fine Needle Aspiration
Tyler Black, Cynthia D. Guy, Rebecca A. Burbridge
Clin Endosc 2013;46(5):595-597.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.595
AbstractAbstract PDFPubReaderePub

Retroperitoneal cystic lymphangiomas are rare tumors of the lymphatic system. These tumors usually present in childhood and are often diagnosed incidentally with imaging procedures. Although benign, they can grow to large sizes and become symptomatic due to their compressive effects. They can cause diagnostic dilemmas with other retroperitoneal cystic tumors including those arising from the liver, kidney, and pancreas. Endoscopic ultrasound (EUS) has become an invaluable tool in the assessment of cystic lesions in the region of the pancreas. This case describes a 66-year-old female who presented with 3 months of abdominal pain. Radiographic imaging was suggestive of a cystic lesion in the region of the pancreas. EUS was performed confirming a cystic lesion adjacent to the tail of the pancreas with subsequent fine needle aspiration fluid analysis consistent with a cystic lymphangioma.

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Special Issue Articles of IDEN 2013
Technical Advances in Endoscopic Ultrasound (EUS)-Guided Tissue Acquisition for Pancreatic Cancers: How Can We Get the Best Results with EUS-Guided Fine Needle Aspiration?
Prashant Kedia, Monica Gaidhane, Michel Kahaleh
Clin Endosc 2013;46(5):552-562.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.552
AbstractAbstract PDFPubReaderePub

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is one of the least invasive and most effective modality in diagnosing pancreatic adenocarcinoma in solid pancreatic lesions, with a higher diagnostic accuracy than cystic tumors. EUS-FNA has been shown to detect tumors less than 3 mm, due to high spatial resolution allowing the detection of very small lesions and vascular invasion, particularly in the pancreatic head and neck, which may not be detected on transverse computed tomography. Furthermore, this minimally invasive procedure is often ideal in the endoscopic procurement of tissue in patients with unresectable tumors. While EUS-FNA has been increasingly used as a diagnostic tool, most studies have collectively looked at all primary pancreatic solid lesions, including lymphomas and pancreatic neuroendocrine neoplasms, whereas very few studies have examined the diagnostic utility of EUS-FNA of pancreatic ductal carcinoma only. As with any novel and advanced endoscopic procedure that may incorporate several practices and approaches, endoscopists have adopted diverse techniques to improve the tissue procurement practice and increase diagnostic accuracy. In this article, we present a review of literature to date and discuss currently practiced EUS-FNA technique, including indications, technical details, equipment, patient selection, and diagnostic accuracy.

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Procore and Flexible 19 Gauge Needle Can Replace Trucut Biopsy Needle?
Ji Young Bang, Shyam Varadarajulu
Clin Endosc 2013;46(5):503-505.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.503
AbstractAbstract PDFPubReaderePub

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is routinely performed for establishing tissue diagnosis in patients with gastrointestinal tumors. The concept of delivering chemotherapy based on molecular markers and the ability to establish a reliable diagnosis in lieu of an onsite cytopathologist has fuelled the recent trend in procuring core tissue by means of EUS-guided fine needle biopsy. To overcome the technical limitations induced by the rigidity of the Trucut biopsy needle, a new ProCore needle with reverse bevel technology has been developed. Recent data suggests that the newly developed flexible 19 gauge needle can also procure core tissue and has easy maneuverability when navigating the transduodenal route. Irrespective of the needles being used, the best clinical outcomes can be attained only by practicing evidence-based techniques, procuring adequate quantity of sample for ancillary studies, and processing the specimens appropriately.

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Endoscopic Ultrasound-Fine Needle Aspiration versus Core Biopsy for the Diagnosis of Subepithelial Tumors
Kevin Webb, Joo Ha Hwang
Clin Endosc 2013;46(5):441-444.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.441
AbstractAbstract PDFPubReaderePub

Subepithelial lesions are frequently encountered and remain a diagnostic challenge. Imaging of subepithelial lesions using endoscopic ultrasound (EUS) can be helpful in narrowing the differential diagnosis of the lesion; however, definitive diagnosis typically requires tissue. Many methods for acquiring tissue exist including EUS-guided fine needle aspiration, Trucut biopsy, and fine needle biopsy. Obtaining adequate tissue is important for cytologic and histologic exams including immunohistochemical stains, thus a great deal of effort has been made to increase tissue acquisition in order to improve diagnostic yield in subepithelial lesions.

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Tissue Acquisition in Gastric Epithelial Tumor Prior to Endoscopic Resection
Chan Gyoo Kim
Clin Endosc 2013;46(5):436-440.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.436
AbstractAbstract PDFPubReaderePub

Endoscopic forceps biopsy is essential before planning an endoscopic resection of upper gastrointestinal epithelial tumors. However, forceps biopsy is limited by its superficiality and frequency of sampling errors. Histologic discrepancies between endoscopic forceps biopsies and resected specimens are frequent. Factors associated with such histologic discrepancies are tumor size, macroscopic type, surface color, and the type of medical facility. Precise targeting of biopsies is recommended to achieve an accurate diagnosis, curative endoscopic resection, and a satisfactory oncologic outcome. Multiple deep forceps biopsies can induce mucosal ulceration in early gastric cancer. Endoscopic resection for early gastric cancer with ulcerative findings is associated with piecemeal resection, incomplete resection, and a risk for procedure-related complications such as bleeding and perforation. Such active ulcers caused by forceps biopsy and following submucosal fibrosis might also be mistaken as an indication for more aggressive procedures, such as gastrectomy with D2 lymph node dissection. Proton pump inhibitors might be prescribed to facilitate the healing of biopsy-induced ulcers if an active ulcer is predicted after deep biopsy. It is unknown which time interval from biopsy to endoscopic resection is appropriate for a safe procedure and a good oncologic outcome. Further investigations are needed to conclude the appropriate time interval.

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Original Article
Concordance of Endoscopic Ultrasonography-Guided Fine Needle Aspiration Diagnosis with the Final Diagnosis in Subepithelial Lesions
Erkan Çağlar, İbrahim Hatemi, Deniz Atasoy, Gürhan Şişman, Hakan Şentürk
Clin Endosc 2013;46(4):379-383.   Published online July 31, 2013
DOI: https://doi.org/10.5946/ce.2013.46.4.379
AbstractAbstract PDFPubReaderePub
Background/Aims

In this study we aimed to determine the rate of concordance of endoscopic ultrasonography (EUS)-guided fine needle aspiration (FNA) diagnosis with the final diagnosis obtained by surgery or endoscopic resection and follow-up in upper gastrointestinal subepithelial lesions.

Methods

We retrospectively studied patients with subepithelial lesions who underwent EUS at our center from 2007 to 2011.

Results

We had a final diagnosis in 67 patients (mean age±SD, 51.23±12.48 years; 23 [34.3%] female, 44 [65.6%] male). EUS-FNA was performed in all of the patients. On-site pathology was not performed. In nine of the patients, the obtained material which was obtained was insufficient. The cytologic examination was benign in 31 and malignant in 27 of the patients. Based on the final diagnosis, the EUS-FNA had a sensitivity of 96%, a specificity of 100%, and a diagnostic yield of 85%.

Conclusions

The diagnostic yield of EUS-FNA, in the absence of the on-site cytopathologist, is feasible for the diagnosis of subepithelial lesions of the upper gastrointestinal system.

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    Beom Jin Kim, Seung Joo Kang, Su Youn Nam, Chang Seok Bang, Byung-Hoon Min, Sung Eun Kim, Seung Young Kim, Hyunchul Lim, Chung Hyun Tae, Moon Won Lee, Seung Han Kim, Sang Hoon Kim, Jong Yeul Lee, Byung-Wook Kim, Jeong Seop Moon, Jong-Jae Park, Hwoon-Yong
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Case Reports
Gastric Schwannoma Diagnosed by Endoscopic Ultrasonography-Guided Trucut Biopsy
Sung Wook Hong, Won Young Cho, Jin-Oh Kim, Chang Gyun Chun, Kwang Yeun Shim, Gene Hyun Bok, Wook Hyun Um, Ji Eun Lee
Clin Endosc 2013;46(3):284-287.   Published online May 31, 2013
DOI: https://doi.org/10.5946/ce.2013.46.3.284
AbstractAbstract PDFPubReaderePub

Schwannomas of the gastrointestinal (GI) tract are rare subepithelial tumors comprising approximately 3.3% to 12.8% of all mesenchymal tumors of the GI tract. On endoscopic ultrasound (EUS) they are seen as hypoechoic tumors arising most commonly from the 4th proper muscle layer. Although EUS helps to distinguish tumor characteristics, tissue sampling is required for differentiation with other more common tumors such as GI stromal tumors. Both EUS-guided fine needle aspiration and EUS-guided trucut biopsy (EUS-TCB) can be used for tissue sampling. However, only EUS-TCB allows core biopsy and a high yield of immunohistochemical staining. We report a case of a gastric schwannoma diagnosed by EUS-TCB.

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Intra-Abdominal Tuberculous Lymphadenitis Diagnosed Using an Endoscopic Ultrasonography-Guided ProCore Needle Biopsy
Tae Hee Lee, Joo Young Cho, Gene Hyun Bok, Won Young Cho, So Young Jin
Clin Endosc 2013;46(1):77-80.   Published online January 31, 2013
DOI: https://doi.org/10.5946/ce.2013.46.1.77
AbstractAbstract PDFPubReaderePub

Intra-abdominal tuberculous lymphadenitis can mimic a variety of other abdominal disorders such as pancreatic cancer, metastatic lymph nodes, or lymphoma, which can make a proper diagnosis difficult. A correct diagnosis of intra-abdominal tuberculous lymphadenitis can lead to appropriate management. Endoscopic ultrasonography (EUS)-guided needle biopsy may be the procedure of choice for tissue acquisition when onsite cytopathology examination is unavailable because it is essential to obtain sufficient material suitable for the examination using an ancillary method, such as flow cytometry, molecular diagnosis, cytogenetics, or microbiological culture. We report a case of intra-abdominal tuberculous lymphadenitis diagnosed using an EUS-guided, 22-gauge histology new needle biopsy without an onsite cytopathology examination.

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    Cynthia L. Harris, Eric M. Toloza, Jason B. Klapman, Shivakumar Vignesh, Kathryn Rodriguez, Frank J. Kaszuba
    Cancer Control.2014; 21(1): 15.     CrossRef
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Pancreatic Pseudocyst after Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pancreatic Mass
Kwang Hyun Chung, Ji Kon Ryu, Hong Sang Oh, Ji Yeon Seo, Eunhyo Jin, Dong Hyeon Lee, Yong-Tae Kim, Yong Bum Yoon
Clin Endosc 2012;45(4):431-434.   Published online November 30, 2012
DOI: https://doi.org/10.5946/ce.2012.45.4.431
AbstractAbstract PDFPubReaderePub

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is well known as a safe diagnostic procedure. We report the first case of pancreatic pseudocyst after EUS-FNA of the pancreatic body mass. A 60-year-old male underwent EUS-FNA for incidentally detected pancreatic solid mass which was suspected as neuroendocrine tumor. Two weeks later, the patient visited emergency room with acute abdominal pain and right upper quadrant tenderness; leukocytosis and elevated C-reactive protein, amylase, and lipase levels were noted. Computed tomography discovered newly developed 11.5×9.5 cm sized cystic mass communicating with the main pancreatic duct. Cyst fluid analysis revealed amylase level of 3,423 U/L and fluid culture isolated Streptococcus parasanguinis. The cystic mass corresponds with pancreatic pseudocyst. FNA induced main pancreatic duct injury and fluid leakage may cause it. Endoscopists who perform EUS-FNA must remember that pancreatic main duct injury can occur as one of severe complications and that it could be treated successfully with endoscopic internal drainage.

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    Mitsuhito Koizumi, Sho Ishikawa, Kaori Marui, Masahito Kokubu, Yusuke Okujima, Yuki Numata, Yoshiki Imamura, Teru Kumagi, Yoichi Hiasa
    Internal Medicine.2024; 63(21): 2943.     CrossRef
  • Needle tract seeding and abscess associated with pancreatic fistula after endoscopic ultrasound-guided fine-needle aspiration
    Takeshi Okamoto, Kenji Nakamura, Ayaka Takasu, Toshimi Kaido, Katsuyuki Fukuda
    Clinical Journal of Gastroenterology.2020; 13(6): 1322.     CrossRef
  • Peripancreatic Fluid Collection Complicated by Endoscopic Ultrasound-Guided Fine-Needle Aspiration
    Tsuyoshi Suda, Kazuya Kitamura, Shuichi Kaneko
    ACG Case Reports Journal.2020; 7(7): e00432.     CrossRef
  • Early pancreatic cancer — The role of endoscopic ultrasound with or without tissue acquisition in diagnosis and staging
    Pedro Moutinho-Ribeiro, Julio Iglesias-Garcia, Rui Gaspar, Guilherme Macedo
    Digestive and Liver Disease.2019; 51(1): 4.     CrossRef
  • Endoscopic ultrasonography guided-fine needle aspiration for the diagnosis of solid pancreaticobiliary lesions: Clinical aspects to improve the diagnosis
    Hiroyuki Matsubayashi
    World Journal of Gastroenterology.2016; 22(2): 628.     CrossRef
  • A Patient with a Wedge-shaped Pulmonary Lesion Associated with Streptococcus parasanguinis
    Hiroya MIYAMOTO, Harumi GOMI, Haruhiko ISHIOKA, taijiro SHIROKAWA
    Kansenshogaku Zasshi.2016; 90(3): 316.     CrossRef
  • Immunodepletion Plasma Proteomics by TripleTOF 5600 and Orbitrap Elite/LTQ-Orbitrap Velos/Q Exactive Mass Spectrometers
    Kelly A. Jones, Phillip D. Kim, Bhavinkumar B. Patel, Steven G. Kelsen, Alan Braverman, Derrick J. Swinton, Philip R. Gafken, Lisa A. Jones, William S. Lane, John M. Neveu, Hon-Chiu E. Leung, Scott A. Shaffer, John D. Leszyk, Bruce A. Stanley, Todd E. Fox
    Journal of Proteome Research.2013; 12(10): 4351.     CrossRef
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Signet-Ring Cell Carcinoma Mimicking Gastric Gastrointestinal Stromal Tumor Confirmed by Endoscopic Ultrasound-Guided Trucut Biopsy
Seong Hun Kim, Soo Teik Lee, Byung Jun Jeon, In Hee Kim, Sang Wook Kim, Seung Ok Lee, Dae Ghon Kim, Ho Sung Park
Clin Endosc 2012;45(4):421-424.   Published online November 30, 2012
DOI: https://doi.org/10.5946/ce.2012.45.4.421
AbstractAbstract PDFPubReaderePub

A submucosal gastric adenocarcinoma, especially the signet ring cell type, is rare. The histologic evaluation techniques for this lesion has not been established; however, histologic confirmation is very important for decision of treatment method. Here, we report a 57-year-old man with a 12-cm gastric submucosal signet ring cell type adenocarcinoma, diagnosed by an endoscopic ultrasound-guided Trucut biopsy and immunochemical studies. This case suggests that the endoscopic ultrasound-guided Trucut biopsy might be a useful diagnostic method in cases of gastric adenocarcinoma with features of gastrointestinal stromal tumor.

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  • Synchronous neuroendocrine tumor and signet ring cell carcinoma in the stomach: a case report and review of literature
    Jian Han, Ying Wang, Hanlin Mu, Jingmei Liu
    Frontiers in Medicine.2025;[Epub]     CrossRef
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    Kyoungwon Jung, Moo In Park
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2021; 21(2): 106.     CrossRef
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    Afrim Avdaj, Ugur Gozalan, Nexhmi Hyseni, Hatim Baxhaku, Sherif Krasniqi, Shpejtim Rramanaj
    Case Reports in Clinical Medicine.2013; 02(06): 358.     CrossRef
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Intramural Hematoma of the Esophagus after Endoscopic Pinch Biopsy
Eun Soo Jeong, Min Jeong Kim, Seung Hyen Yoo, Dong Hyun Kim, Jin Sung Jung, Nam Ho Koo, Se Heon Chang
Clin Endosc 2012;45(4):417-420.   Published online November 30, 2012
DOI: https://doi.org/10.5946/ce.2012.45.4.417
AbstractAbstract PDFPubReaderePub

Intramural hematoma of the esophagus (IHE) is an uncommon form of esophageal injury, which may be an intermediate of mucosal tear (Mallory-Weiss syndrome) or transmural rupture (Boerhaave's syndrome). To date, the pathogenesis of IHE has not been well documented. IHE may occur within the submucosal layer of the esophagus following dissection of the mucosa. The most commonly presented symptoms are sudden retrosternal pain, dysphagia and hematemesis. The disorder can occur spontaneously or secondarily to trauma. In this report, we present a case of IHE which occurred after endoscopic biopsy and was recovered following conservative management in a patient who was taking long-term aspirin medication.

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    Shintaro Uchida, Hideyuki Saito, Kengo Kuriyama, Tomonori Yoshida, Keigo Hara, Makoto Sakai, Makoto Sohda, Hiroshi Saeki, Ken Shirabe
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    Liang Liu, Xing-Jie Shen, Li-Jun Xue, Shu-Kun Yao, Jing-Yu Zhu
    World Journal of Clinical Cases.2021; 9(20): 5683.     CrossRef
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    Şehmus ÖLMEZ, Adnan TAŞ, Banu KARA, Bünyamin SARITAŞ
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    Sachiko Ito, Shihoko Iwata, Izumi Kondo, Motoyo Iwade, Makoto Ozaki, Tatsuya Ishikawa, Takakazu Kawamata
    JA Clinical Reports.2017;[Epub]     CrossRef
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    A.F. Romano-Munive, G. Grajales-Figueroa, F.I. Téllez-Ávila
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    Yuri Fujimoto, Kazuhiro Shirozu, Noritoshi Shirozu, Kozaburo Akiyoshi, Ataru Nishimura, Sho Kawasaki, Yoshimasa Motoyama, Tadashi Kandabashi, Koji Iihara, Sumio Hoka
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    SM Noor Hossain, John de Caestecker
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  • 8 Crossref
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