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18 "Endoscopic ultrasound-guided fine needle aspiration"
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Original Article
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
Received May 30, 2024  Accepted August 5, 2024  Published online December 12, 2024  
DOI: https://doi.org/10.5946/ce.2024.143    [Epub ahead of print]
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.
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Review
Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for pancreatic cystic lesions: current status and future prospects
Clement Chun Ho Wu, Samuel Jun Ming Lim, Damien Meng Yew Tan
Clin Endosc 2024;57(4):434-445.   Published online July 8, 2024
DOI: https://doi.org/10.5946/ce.2023.157
AbstractAbstract PDFPubReaderePub
Pancreatic cystic lesions (PCLs) have increased in prevalence due to the increased usage and advancements in cross-sectional abdominal imaging. Current diagnostic techniques cannot distinguish between PCLs requiring surgery, close surveillance, or expectant management. This has increased the morbidity and healthcare costs from inappropriately aggressive and conservative management strategies. Endoscopic ultrasound (EUS) needle-based confocal laser endomicroscopy (nCLE) allows for microscopic examination and delineation of the surface epithelium of PCLs. Landmark studies have identified characteristics distinguishing various types of PCLs, confirmed the high diagnostic yield of EUS-nCLE (especially for PCLs with an equivocal diagnosis), and shown that EUS-nCLE helps to change management and reduce healthcare costs. Refining procedure technique and reducing procedure length have improved the safety of EUS-nCLE. The utilization of artificial intelligence and its combination with other EUS-based advanced diagnostic techniques would further improve the results of EUS-based PCL diagnosis. A structured training program and device improvements to allow more complete mapping of the pancreas cyst epithelium will be crucial for the widespread adoption of this promising technology.

Citations

Citations to this article as recorded by  
  • Endoscopic techniques for the diagnosis of pancreatic cystic lesions
    Sahib Singh, Saurabh Chandan, Rakesh Vinayek, Jahnvi Dhar, Jayanta Samanta, Gabriele Capurso, Ivo Boskoski, Cristiano Spada, Jorge D Machicado, Stefano Francesco Crinò, Antonio Facciorusso
    World Journal of Gastroenterology.2025;[Epub]     CrossRef
  • Pathognomonic Signs in Pancreatic Cystic Lesions: What Gastroenterologists and Involved Clinicians Need to Know
    Alberto Martino, Luca Barresi, Francesco Paolo Zito, Michele Amata, Roberto Fiorentino, Severo Campione, Alessandro Iacobelli, Enrico Crolla, Roberto Di Mitri, Carlo Molino, Marco Di Serafino, Giovanni Lombardi
    Gastroenterology Insights.2024; 15(3): 810.     CrossRef
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Original Articles
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  
  • 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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Clinical utility of endoscopic ultrasound-guided tissue acquisition for comprehensive genomic profiling of pancreatic cancer
Nozomi Okuno, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Yasuhiro Kuraishi, Daiki Fumihara, Takafumi Yanaidani
Clin Endosc 2023;56(2):221-228.   Published online March 7, 2023
DOI: https://doi.org/10.5946/ce.2022.086
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is essential for the diagnosis of pancreatic cancer. The feasibility of comprehensive genomic profiling (CGP) using samples obtained by EUS-TA has been under recent discussion. This study aimed to evaluate the utility of EUS-TA for CGP in a clinical setting.
Methods
CGP was attempted in 178 samples obtained from 151 consecutive patients with pancreatic cancer at the Aichi Cancer Center between October 2019 and September 2021. We evaluated the adequacy of the samples for CGP and determined the factors associated with the adequacy of the samples obtained by EUS-TA retrospectively.
Results
The overall adequacy for CGP was 65.2% (116/178), which was significantly different among the four sampling methods (EUS-TA vs. surgical specimen vs. percutaneous biopsy vs. duodenal biopsy, 56.0% [61/109] vs. 80.4% [41/51] vs. 76.5% [13/17] vs. 100.0% [1/1], respectively; p=0.022). In a univariate analysis, needle gauge/type was associated with adequacy (22 G fine-needle aspiration vs. 22 G fine-needle biopsy [FNB] vs. 19 G-FNB, 33.3% (5/15) vs. 53.5% (23/43) vs. 72.5% (29/40); p=0.022). The sample adequacy of 19 G-FNB for CGP was 72.5% (29/40), and there was no significant difference between 19 G-FNB and surgical specimens (p=0.375).
Conclusions
To obtain adequate samples for CGP with EUS-TA, 19 G-FNB was shown to be the best in clinical practice. However, 19 G-FNB was not still sufficient, so further efforts are required to improve adequacy for CGP.

Citations

Citations to this article as recorded by  
  • Updated techniques and evidence for endoscopic ultrasound‐guided tissue acquisition from solid pancreatic lesions
    Masahiro Itonaga, Reiko Ashida, Masayuki Kitano
    DEN Open.2025;[Epub]     CrossRef
  • Tissue acquisition for comprehensive genomic profiling of gallbladder cancer using a forward-viewing echoendoscope in a patient who underwent Roux-en-Y reconstruction
    Michihiro Ono, Shutaro Oiwa, Atsushi Uesugi, Seiya Saito, Ryota Yokoyama, Makoto Usami, Tomoyuki Abe, Miri Fujita, Kohichi Takada, Masahiro Maeda
    Clinical Journal of Gastroenterology.2024; 17(1): 164.     CrossRef
  • Endoscopic ultrasound-guided tissue acquisition for comprehensive genomic profiling
    Nozomi Okuno, Kazuo Hara
    Journal of Medical Ultrasonics.2024; 51(2): 253.     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
  • 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
  • Mcl-1 expression is a predictive marker of response to gemcitabine plus nab-paclitaxel for metastatic pancreatic cancer
    Makiko Urabe, Kenji Ikezawa, Yusuke Seiki, Ko Watsuji, Yasuharu Kawamoto, Takeru Hirao, Yugo Kai, Ryoji Takada, Takuo Yamai, Kaori Mukai, Tasuku Nakabori, Hiroyuki Uehara, Shigenori Nagata, Kazuyoshi Ohkawa
    Scientific Reports.2024;[Epub]     CrossRef
  • Endoscopic ultrasound-guided tissue acquisition for personalized treatment in pancreatic adenocarcinoma
    Sang Myung Woo
    Clinical Endoscopy.2023; 56(2): 183.     CrossRef
  • Comparison of the novel Franseen needle versus the fine‐needle aspiration needle in endoscopic ultrasound‐guided tissue acquisition for cancer gene panel testing: A propensity score‐matching analysis
    Tomotaka Mori, Eisuke Ozawa, Akane Shimakura, Kosuke Takahashi, Satoshi Matsuo, Kazuaki Tajima, Yasuhiko Nakao, Masanori Fukushima, Ryu Sasaki, Satoshi Miuma, Hisamitsu Miyaaki, Shinji Okano, Kazuhiko Nakao
    JGH Open.2023; 7(9): 652.     CrossRef
  • Editorial: Endoscopic ultrasound‐guided tissue acquisition in the era of precision medicine
    Tiing Leong Ang, James Weiquan Li, Lai Mun Wang
    Journal of Gastroenterology and Hepatology.2023; 38(10): 1677.     CrossRef
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Utility of forward-view endoscopic ultrasound in fine-needle aspiration in patients with a surgically altered upper gastrointestinal anatomy
Asmaa Bakr, Kazuo Hara, Moaz Elshair, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Daiki Fumihara, Takafumi Yanaidani, Samy Zaky, Hanaa Omar
Clin Endosc 2023;56(3):367-374.   Published online January 5, 2023
DOI: https://doi.org/10.5946/ce.2021.238
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) using oblique-view EUS in patients with a surgically altered anatomy (SAA) of the upper gastrointestinal tract is limited because of difficult scope insertion due to the disturbed anatomy. This study aimed to investigate the efficiency of forward-view (FV)-EUS in performing FNA in patients with a SAA.
Methods
We retrospectively investigated 32 patients with a SAA of the upper gastrointestinal tract who visited Aichi Cancer Center Hospital in Nagoya, Japan, between January 2014 and December 2020. We performed-upper gastrointestinal EUS-FNA using FV-EUS combined with fluoroscopic imaging to confirm tumor recurrence or to make a decision before chemotherapy or after a failure of diagnosis by radiology.
Results
We successfully performed EUS-FNA in all studied patients (100% technical success), with the specificity, sensitivity, and accuracy of 100%, 87.5%, and 87.8%, respectively, with no complications.
Conclusions
EUS-FNA using FV-EUS combined with fluoroscopic imaging is an effective and safe technique for tissue acquisition in patients with a SAA.
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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.

Citations

Citations to this article as recorded by  
  • 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
  • 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.2024;[Epub]     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
    Diagnostics.2021; 11(8): 1314.     CrossRef
  • 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
  • 4,406 View
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  • 7 Web of Science
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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.

Citations

Citations to this article as recorded by  
  • Primary Pancreatic Lymphoma: Endosonography-Guided Tissue Acquisition Diagnosis
    Anna Carolina Orsini-Arman , Rodrigo Cañada T Surjan, Filadélfio E Venco, José C Ardengh
    Cureus.2023;[Epub]     CrossRef
  • Diagnostic Yield of Serial Pancreatic Juice Aspiration Cytologic Examination With Brush Cytology for Pancreatic Ductal Stenosis
    Takafumi Mie, Takashi Sasaki, Tsuyoshi Takeda, Takeshi Okamoto, Chinatsu Mori, Takaaki Furukawa, Yuto Yamada, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
    Pancreas.2022; 51(8): 995.     CrossRef
  • Pancreatic follicular lymphoma: a report of two cases and literature review
    Takeshi Okamoto, Takashi Sasaki, Noriko Nishimura, Manabu Takamatsu, Chinatsu Mori, Takafumi Mie, Takaaki Furukawa, Yuto Yamada, Tsuyoshi Takeda, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Dai Maruyama, Naoki Sasahira
    Clinical Journal of Gastroenterology.2021; 14(6): 1756.     CrossRef
  • 4,662 View
  • 101 Download
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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.

Citations

Citations to this article as recorded by  
  • Optimal resection of gastric bronchogenic cysts based on anatomical continuity with adherent gastric muscular layer: A case report
    Masayoshi Terayama, Koshi Kumagai, Hiroshi Kawachi, Rie Makuuchi, Masaru Hayami, Satoshi Ida, Manabu Ohashi, Takeshi Sano, Souya Nunobe
    World Journal of Gastrointestinal Surgery.2023; 15(6): 1216.     CrossRef
  • Retroperitoneal tumor finally diagnosed as a bronchogenic cyst: A case report and review of literature
    Yang-Yang Gong, Xin Qian, Bo Liang, Ming-Dong Jiang, Jun Liu, Xing Tao, Jing Luo, Hong-Jian Liu, You-Gang Feng
    World Journal of Clinical Cases.2022; 10(19): 6679.     CrossRef
  • Endoscopic resection in the treatment of intramural esophageal bronchogenic cysts: A retrospective analysis of 17 cases
    Jiao Jiao, Xiaofei Fan, Lili Luo, Zhongqing Zheng, Bangmao Wang, Wentian Liu
    Digestive and Liver Disease.2022; 54(12): 1691.     CrossRef
  • Subdiaphragmatic bronchogenic cysts: Case series and literature review
    Jianchun Xiao, Xueyang Zhang, Hongru Zhou, Tao Hong, Binglu Li, Xiaodong He, Wei Liu
    Frontiers in Medicine.2022;[Epub]     CrossRef
  • 4,293 View
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  • 5 Web of Science
  • 4 Crossref
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Original Articles
Endoscopic Ultrasound-Guided Random Omental Fine Needle Aspiration: A Novel Technique for the Diagnosis of Peritoneal Carcinomatosis
Pradeep Kumar Siddappa, Neha Jain, Naveen K. Agarwal, Monika Jain, Gurwant Singh Lamba
Clin Endosc 2020;53(5):594-599.   Published online September 29, 2020
DOI: https://doi.org/10.5946/ce.2019.175
AbstractAbstract PDFPubReaderePub
Background
/Aims: Diagnostic abdominal paracentesis has been described in literature to have variable sensitivity of 50%–75% for the detection of peritoneal carcinomatosis (PC). We believe that random needle aspirates from the omentum, even in the absence of obvious deposits by endoscopic ultrasound (EUS), could prove malignancy in patients with PC.
Methods
Consecutive patients who underwent EUS for diagnosis and staging of cancer and found to have ascites were included after obtaining informed consent. EUS-guided fine needle aspiration (EUS-FNA) from random sites in the omentum was performed through the transgastric route using a linear echoendoscope.
Results
Fifty-four patients underwent EUS during October 2015 to April 2017 for detection, staging, or FNA of a suspected malignant lesion. Ascites was seen in 17 patients and 15 patients who fulfilled the criteria were included. The procedure was successful in all patients. Cytology was suggestive of malignancy in 12 (80%) but not suggestive of malignancy in 3 (20%) patients. Three patients who tested negative had hyperbilirubinemia with biliary obstruction. Their ascitic fluid analysis result was also negative.
Conclusions
Random FNA of the omentum in patients with malignancy-related ascites is highly effective in the diagnosis of PC and could be employed during EUS evaluation of malignancies.

Citations

Citations to this article as recorded by  
  • Role of Endoscopic Ultrasound in Diagnosis of Pancreatic Ductal Adenocarcinoma
    Abhirup Chatterjee, Jimil Shah
    Diagnostics.2023; 14(1): 78.     CrossRef
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  • 80 Download
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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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Rapid On-Site Evaluation by Endosonographers during Endoscopic Ultrasonography-Guided Fine-Needle Aspiration for Diagnosis of Gastrointestinal Stromal Tumors
Takashi Tamura, Yasunobu Yamashita, Kazuki Ueda, Yuki Kawaji, Masahiro Itonaga, Shin-ichi Murata, Kaori Yamamoto, Takeichi Yoshida, Hiroki Maeda, Takao Maekita, Mikitaka Iguchi, Hideyuki Tamai, Masao Ichinose, Jun Kato
Clin Endosc 2017;50(4):372-378.   Published online January 20, 2017
DOI: https://doi.org/10.5946/ce.2016.083
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been used to diagnose gastrointestinal submucosal tumors (SMTs). Although rapid on-site evaluation (ROSE) has been reported to improve the diagnostic accuracy of EUS-FNA for pancreatic lesions, on-site cytopathologists are not routinely available. Given this background, the usefulness of ROSE by endosonographers themselves for pancreatic tumors has also been reported. However, ROSE by endosonographers for diagnosis of SMT has not been reported. The aim of this study was to evaluate the diagnostic accuracy of EUS-FNA with ROSE by endosonographers for SMT, focusing on diagnosis of gastrointestinal stromal tumor (GIST), compared with that of EUS-FNA alone.
Methods
Twenty-two consecutive patients who underwent EUS-FNA with ROSE by endosonographers for SMT followed by surgical resection were identified. Ten historical control subjects who underwent EUS-FNA without ROSE were used for comparison.
Results
The overall diagnostic accuracy for SMT was significantly higher in cases with than without ROSE (100% vs. 80%, p=0.03). The number of needle passes by FNA with ROSE by endosonographers tended to be fewer, although accuracy was increased (3.3±1.3 vs. 5.9±3.8, p=0.06).
Conclusions
ROSE by endosonographers during EUS-FNA for SMT is useful for definitive diagnosis, particularly for GIST.

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Case Report
Could Transgastric Endoscopic Ultrasound-Guided Aspiration Alone Be Effective for the Treatment of Pancreatic Abscesses?
Hoon-Gil Jo, Baatarnum Amarbat, Jin-Woo Jeong, Hyo-Yeop Song, Seung-Ryel Song, Tae-Hyeon Kim
Clin Endosc 2015;48(4):345-347.   Published online July 24, 2015
DOI: https://doi.org/10.5946/ce.2015.48.4.345
AbstractAbstract PDFPubReaderePub

Drainage of pancreatic abscesses is required for effective control of sepsis. Endoscopic ultrasound (EUS)-guided endoscopic drainage is less invasive than surgery and prevents local complications related to percutaneous drainage. Endoscopic drainage with stent placement in the uncinate process of the pancreas is a technically difficult procedure. We report a case of pancreatic abscess treated by repeated EUS-guided aspiration and intravenous antibiotics without an indwelling drainage catheter or surgical intervention.

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Original Articles
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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    Alain Tremblay, Seamus McFadden, Martina Bonifazi, Valentina Luzzi, Samuel V. Kemp, Stefano Gasparini, Alex Chee, Paul MacEachern, Elaine Dumoulin, Christopher A. Hergott, Pallav L. Shah
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    César Vivian LOPES, Antônio Atalíbio HARTMANN, Everson Luiz de Almeida ARTIFON
    ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo).2018;[Epub]     CrossRef
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    Andrés Poveda, Xavier García del Muro, Jose Antonio López-Guerrero, Ricardo Cubedo, Virginia Martínez, Ignacio Romero, César Serrano, Claudia Valverde, Javier Martín-Broto
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    Ashley L. Faulx, Shivangi Kothari, Ruben D. Acosta, Deepak Agrawal, David H. Bruining, Vinay Chandrasekhara, Mohamad A. Eloubeidi, Robert D. Fanelli, Suryakanth R. Gurudu, Mouen A. Khashab, Jenifer R. Lightdale, V. Raman Muthusamy, Aasma Shaukat, Bashar J
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  • Contrast‐enhanced harmonic endoscopic ultrasonography for differential diagnosis of submucosal tumors of the upper gastrointestinal tract
    Ken Kamata, Mamoru Takenaka, Masayuki Kitano, Shunsuke Omoto, Takeshi Miyata, Kosuke Minaga, Kentaro Yamao, Hajime Imai, Toshiharu Sakurai, Tomohiro Watanabe, Naoshi Nishida, Takaaki Chikugo, Yasutaka Chiba, Haruhiko Imamoto, Takushi Yasuda, Andrea Lisott
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    Gandhi Lanke, Jeffrey H Lee
    World Journal of Clinical Oncology.2017; 8(2): 135.     CrossRef
  • EUS-guided 22-gauge fine needle biopsy for the diagnosis of gastric subepithelial tumors larger than 2 cm
    Jeong Hoon Lee, Charles J. Cho, Young Soo Park, Ji Yong Ahn, Do Hoon Kim, Hee Kyong Na, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung
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  • Response:
    Moon Kyung Joo, Jong-Jae Park
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    Pujan Kandel, Ghassan Tranesh, Aziza Nassar, Russell Bingham, Massimo Raimondo, Timothy A. Woodward, Victoria Gomez, Michael B. Wallace
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    Eun Jeong Gong, Kee Don Choi
    Clinical Endoscopy.2016; 49(6): 498.     CrossRef
  • A Case of Gastrointestinal Stromal Tumor That Underwent Endoscopic Ultrasound-Guided Aspiration with a 25-Gauge Biopsy Needle
    Minoru Tomizawa, Fuminobu Shinozaki, Yasufumi Motoyoshi, Takao Sugiyama, Shigenori Yamamoto, Naoki Ishige
    Case Reports in Gastroenterology.2016; 10(1): 173.     CrossRef
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    Darshana Jhala
    Diagnostic Histopathology.2015; 21(12): 462.     CrossRef
  • Which Needle Is Better for Diagnosing Subepithelial Lesions?
    Eun Young Kim
    Clinical Endoscopy.2015; 48(2): 91.     CrossRef
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Performance and Clinical Role of Endoscopic Ultrasound Fine Needle Aspiration for Diagnosing Gastrointestinal Intramural Lesions
Hea Jung Sung, Yu Kyung Cho, Eun Young Park, Sung Jin Moon, Chul Hyun Lim, Jin Su Kim, Jae Myung Park, In Seok Lee, Sang Woo Kim, Myung-Gyu Choi, Kyu Yong Choi
Clin Endosc 2013;46(6):627-632.   Published online November 19, 2013
DOI: https://doi.org/10.5946/ce.2013.46.6.627
AbstractAbstract PDFPubReaderePub
Background/Aims

We evaluated the performance, clinical role, and diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in gastrointestinal intramural lesions.

Methods

Procedural and pathologic data were reviewed from consecutive patients undergoing EUS-FNA for intramural lesions. Final diagnoses were determined by surgical histopathologic conformation and the diagnosis of malignancy, including clinical follow-up with repeat imaging.

Results

Forty-six patients (mean age, 47 years; 24 males) underwent EUS-FNA. Lesions were located in the stomach (n=31), esophagus (n=5), and duodenum (n=10). The median lesion size was 2 cm (range, 1 to 20.6). Final diagnoses were obtained in 22 patients (48%). EUS-FNA was diagnostic in 40 patients (87%). The diagnostic accuracy of cytology for differentiating between benign and malignant lesions was 82%; diagnostic error occurred in three patients (6%). The cytologic results influenced clinical judgment in 78% cases. The primary reasons for negative or no clinical impact were false-negative results, misdirected patient management, and inconclusive cytology.

Conclusions

EUS-FNA exhibited an 87% diagnostic yield for gastrointestinal intramural lesions; the accuracy of cytology for differentiating malignancy was 82%. The limitations of EUS-FNA were primarily because of nondiagnostic sampling (9%) and probable diagnostic error (6%); these factors may influence the clinical role of EUS-FNA.

Citations

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    Li Tao, Yajun Chen, Qianqian Fang, Fan Xu, Qianwei Yu, Lijiu Zhang, Xiangpeng Hu
    Scientific Reports.2024;[Epub]     CrossRef
  • Endoscopic ultrasound‐guided fine needle aspiration cytology diagnosis of upper gastrointestinal tract mesenchymal tumors: Impact of rapid onsite evaluation and correlation with histopathologic follow‐up
    Syed M. Gilani, Thiruvengadam Muniraj, Harry R. Aslanian, Guoping Cai
    Diagnostic Cytopathology.2021; 49(2): 203.     CrossRef
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    Eun Young Kim
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2015; 15(1): 9.     CrossRef
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    Yeon Suk Kim
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Special Issue Articles of IDEN 2013
Role of Repeated Endoscopic Ultrasound-Guided Fine Needle Aspiration for Inconclusive Initial Cytology Result
Eun Young Kim
Clin Endosc 2013;46(5):540-542.   Published online September 30, 2013
DOI: https://doi.org/10.5946/ce.2013.46.5.540
AbstractAbstract PDFPubReaderePub

For tissue diagnosis of suspected pancreatic cancer, endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the procedure of choice with high safety and accuracy profiles. However, about 10% of cytologic findings of EUS-FNA are inconclusive. In that situation, careful observation, surgical exploration, or alternative diagnostic tools such as bile duct brushing with endoscopic retrograde cholangiopancreatography or computed tomography-guided biopsy can be considered. However, some concerns and/or risks of these options render repeat EUS-FNA a reasonable choice. Repeated EUS-FNA may impose substantial clinical impact with low risk.

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    Hyung Ku Chon, Keum Ha Choi, Tae Hyeon Kim
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    Bo Sun, Xiujiang Yang, Bo Ping, Yiping He, Zhaozhen Zhang
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  • 4 Crossref
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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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    Amin K. Soltani, Kumar Krishnan
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    Michael Hocke, Barbara Braden, Christian Jenssen, Christoph F. Dietrich
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    Eun Young Kim
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    Kazuo Hara, Nobumasa Mizuno, Susumu Hijioka, Hiroshi Imaoka, Masahiro Tajika, Tsutomu Tanaka, Makoto Ishihara, Yasumasa Niwa, Kenji Yamao
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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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    Hyunchul Lim
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    Woo Hyun Paik, Dong Wan Seo
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    Hongbo Shan, Xiaoyan Gao, Guangyu Luo, Jieqing Xiang, Bilv Zhong, Xiaofang Qiu, Shiyong Lin, Shuhong Li, Yin Li, Guoliang Xu, Rong Zhang
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    Eun Young Kim
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2015; 15(1): 9.     CrossRef
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    Eun Young Kim
    Clinical Endoscopy.2015; 48(2): 91.     CrossRef
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Case Report
Hepatic and Splenic Infarction and Bowel Ischemia Following Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis
Hee Yoon Jang, Sang-Woo Cha, Byung Hoo Lee, Ho Eun Jung, Jin Woo Choo, Yun-Ju Cho, Hye Young Ju, Young Deok Cho
Clin Endosc 2013;46(3):306-309.   Published online May 31, 2013
DOI: https://doi.org/10.5946/ce.2013.46.3.306
AbstractAbstract PDFPubReaderePub

Endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) is a well-established intervention to palliate malignant pain. We report a patient who developed hepatic and splenic infarction and bowel ischemia following EUS-CPN. A 69-year-old man with known lung cancer and pancreatic metastasis was transferred for debilitating, significant epigastric pain for several months. The patient underwent EUS-CPN to palliate the pain. After the procedure, the patient complained continuously of abdominal pain, nausea, and vomiting; hematemesis and hematochezia were newly developed. Abdominal computed tomography revealed infarction of the liver and spleen and ischemia of the stomach and proximal small bowel. On esophagogastroduodenoscopy, hemorrhagic gastroduodenitis, and multiple gastric ulcers were noted without active bleeding. The patient expired on postoperative day 27 despite the best supportive care.

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    Amit H. Sachdev, Frank G. Gress
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    Pilar Castro Carbajo, Lydia Elena Pradera Andrés, Carolina Navarro, Luis Ramón Rábago Torres
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    Ichiro Yasuda, Hsiu‐Po Wang
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    Vishal B. Gohil, Jason B. Klapman
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    Fan-Sheng Meng
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