Clinical Endoscopy

Original Articles

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

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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

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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

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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

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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

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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
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

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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

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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

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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;[Epub] 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

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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

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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.

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Effect of wet-heparinized suction on the quality of mediastinal solid tumor specimens obtained by endoscopic ultrasound-guided fine-needle aspiration: a retrospective study from a single center
Bo Xu, Qian Lu, Rong Fang, Xiaojuan Dai, Haiyan Xu, Xiangwu Ding, Huawei Gui
BMC Gastroenterology.2023;[Epub] CrossRef
Randomized controlled trial comparing the Franseen needle with the Fork-tip needle for EUS-guided fine-needle biopsy
Munish Ashat, Jagpal S. Klair, Sydney L. Rooney, Sagar J. Vishal, Chris Jensen, Nadav Sahar, Arvind R. Murali, Rami El-Abiad, Henning Gerke
Gastrointestinal Endoscopy.2021; 93(1): 140. CrossRef

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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

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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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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
Endoscopic Ultrasound.2024;[Epub] CrossRef
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
Cancers.2024; 16(15): 2721. CrossRef
Endoscopic ultrasound-guided fine-needle biopsy diagnosing pancreatic metastasis seven years after renal leiomyosarcoma resection: a case report
Takuya Okamoto, Shuhei Shintani, Hiromitsu Maehira, Kosuke Hiroe, Shiori Onoda, Hidenori Kimura, Atsushi Nishida, Masaji Tani, Ryoji Kushima, Osamu Inatomi
Clinical Journal of Gastroenterology.2024;[Epub] CrossRef
How to optimize the diagnostic yield of endoscopic ultrasound-guided fine-needle sampling in solid pancreatic lesions from a technical perspective
Nam Hee Kim, Hong Joo Kim
International Journal of Gastrointestinal Intervention.2023; 12(2): 57. CrossRef
Efficacy of endoscopic ultrasound-guided tissue acquisition for solid pancreatic lesions 20 mm or less in diameter suspected as neuroendocrine tumors or requiring differentiation
Yuki Kawasaki, Susumu Hijioka, Yoshikuni Nagashio, Yuta Maruki, Akihiro Ohba, Kotaro Takeshita, Tetsuro Takasaki, Daiki Agarie, Yuya Hagiwara, Hidenobu Hara, Kohei Okamoto, Daiki Yamashige, Shunsuke Kondo, Chigusa Morizane, Hideki Ueno, Takahiro Mizui, Ta
Journal of Gastroenterology.2023; 58(7): 693. CrossRef
Performance of EUS-FNB in solid pancreatic masses: a lesson from 463 consecutive procedures and a practical nomogram
Nico Pagano, Claudio Ricci, Carlo Ingaldi, Sinan Sadalla, Andrea Fabbri, Laura Alberici, Giovanna Impellizeri, Socrate Pallio, Rocco Maurizio Zagari, Antonio De Leo, Matteo Cescon, Riccardo Casadei
Updates in Surgery.2022; 74(3): 945. CrossRef
Diagnostic Value and Influencing Factors of EUS-FNA in Pancreatic Solid Masses
培君任
Advances in Clinical Medicine.2022; 12(05): 3931. CrossRef
Diagnostic performance of endoscopic ultrasound-guided tissue acquisition by EUS-FNA versus EUS-FNB for solid pancreatic mass without ROSE: a retrospective study
Thanawin Wong, Tanawat Pattarapuntakul, Nisa Netinatsunton, Bancha Ovartlarnporn, Jaksin Sottisuporn, Naichaya Chamroonkul, Pimsiri Sripongpun, Sawangpong Jandee, Apichat Kaewdech, Siriboon Attasaranya, Teerha Piratvisuth
World Journal of Surgical Oncology.2022;[Epub] CrossRef
Safety and Efficacy of Ultrasound-Guided Percutaneous Core Needle Biopsy of Pancreatic and Peripancreatic Lesions Adjacent to Critical Vessels
Sun Hwa Chung, Hyun Ji Kang, Hyo Jeong Lee, Jin Sil Kim, Jeong Kyong Lee
Journal of the Korean Society of Radiology.2021; 82(5): 1207. CrossRef

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Case Report

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

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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

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Rare case of solid pseudopapillary neoplasm of the pancreas with liver and splenic metastasis in a 19-year-old girl
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
Large Solid Pseudopapillary Tumor Pancreas with Extensive Splenoportal Thrombosis and Malignant Transformation—A Rare Entity
Thara Pratap, Dhanya Jacob, Abhishek Yadav, Muhammed Jasim Abdul Jalal, Iona Leekha Mathew
Journal of Gastrointestinal and Abdominal Radiology.2022; 05(03): 196. CrossRef
Aggressive solid pseudopapillary tumor of the pancreas. (Literature review and case report)
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
Onkologiya. Zhurnal imeni P.A.Gertsena.2022; 11(2): 52. CrossRef

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Original Article

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

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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.

Citations

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Comparison of Franseen and novel tricore needles for endoscopic ultrasound-guided fine-needle biopsy in a porcine liver model
Yubeen Park, Jeon Min Kang, Ji Won Kim, Dong-Sung Won, Dae Sung Ryu, Song Hee Kim, Chae Eun Yun, Seung Jin Eo, Jung-Hoon Park, Sang Soo Lee
Scientific Reports.2024;[Epub] CrossRef
The Role of Endoscopic Ultrasound in Hepatology
Saleh A. Alqahtani, Floriane Ausloos, Ji Seok Park, Sunguk Jang
Gut and Liver.2023; 17(2): 204. CrossRef
EUS Guided Liver Biopsy
Itegbemie Obaitan, Romil Saxena, Mohammad A Al-Haddad
Techniques and Innovations in Gastrointestinal Endoscopy.2022; 24(1): 66. CrossRef
Endoscopic Ultrasound-Guided Liver Biopsy
Ishaan K. Madhok, Nasim Parsa, Jose M. Nieto
Clinics in Liver Disease.2022; 26(1): 127. CrossRef
Role of endoscopic ultrasound-guided liver biopsy: a meta-analysis
Keyu Zeng, Zhenpeng Jiang, Jie Yang, Kefei Chen, Qiang Lu
Scandinavian Journal of Gastroenterology.2022; 57(5): 545. CrossRef
Update on endoscopic ultrasound-guided liver biopsy
Shiva Rangwani, Devarshi R Ardeshna, Khalid Mumtaz, Sean G Kelly, Samuel Y Han, Somashekar G Krishna
World Journal of Gastroenterology.2022; 28(28): 3586. CrossRef
EUS-guided versus percutaneous liver biopsy: A comprehensive review and meta-analysis of outcomes
Saurabh Chandan, Smit Deliwala, Shahab R. Khan, Babu P. Mohan, Banreet S. Dhindsa, Jay Bapaye, Hemant Goyal, Lena L. Kassab, Faisal Kamal, Harlan R. Sayles, Gursimran S. Kochhar, Douglas G. Adler
Endoscopic Ultrasound.2022;[Epub] CrossRef
Diagnostic and interventional EUS in hepatology: An updated review
Vaneet Jearth, Sridhar Sundaram, SurinderSingh Rana
Endoscopic Ultrasound.2022; 11(5): 355. CrossRef
Endoscopic ultrasound guided hepatic interventions
Rintaro Hashimoto, Kenneth J. Chang
Digestive Endoscopy.2021; 33(1): 54. CrossRef
Comparison of Two Specialized Histology Needles for Endoscopic Ultrasound (EUS)-Guided Liver Biopsy: A Pilot Study
Rintaro Hashimoto, David P. Lee, Jason B. Samarasena, Vishal S. Chandan, Wenchang Guo, John G. Lee, Kenneth J. Chang
Digestive Diseases and Sciences.2021; 66(5): 1700. CrossRef
Emerging role of endoscopic ultrasound-guided liver biopsy
John David Chetwood, Sanjivan Mudaliar, Dominic Staudenmann, Joo-Shik Shin, Ken Liu, Avik Majumdar, Arthur Kaffes, Simone Strasser, Geoffrey W McCaughan, Payal Saxena
Gut.2021; 70(8): 1600. CrossRef
A prospective, head-to-head comparison of 2 EUS-guided liver biopsy needles in vivo
Soorya N. Aggarwal, Travis Magdaleno, Farina Klocksieben, Jennifer E. MacFarlan, Shanth Goonewardene, Zachary Zator, Shashin Shah, Hiral N. Shah
Gastrointestinal Endoscopy.2021; 93(5): 1133. CrossRef
Endoscopic Ultrasound-Guided Fine Needle Aspiration Using a 22-G Needle for Hepatic Lesions: Single-Center Experience
Ebru Akay, Deniz Atasoy, Engin Altınkaya, Ali Koç, Tamer Ertan, Hatice Karaman, Erkan Caglar
Clinical Endoscopy.2021; 54(3): 404. CrossRef
How Can We Optimize Tools and Techniques for Endoscopic Ultrasound–Guided Liver Biopsy?
Itegbemie Obaitan, Mohammad A. Al-Haddad
Clinical Gastroenterology and Hepatology.2020; 18(5): 1025. CrossRef
Guidelines on the use of liver biopsy in clinical practice from the British Society of Gastroenterology, the Royal College of Radiologists and the Royal College of Pathology
James Neuberger, Jai Patel, Helen Caldwell, Susan Davies, Vanessa Hebditch, Coral Hollywood, Stefan Hubscher, Salil Karkhanis, Will Lester, Nicholas Roslund, Rebecca West, Judith I Wyatt, Mathis Heydtmann
Gut.2020; 69(8): 1382. CrossRef
Endoscopic ultrasound in chronic liver disease
Brian M Fung, Alexander P Abadir, Armen Eskandari, Michael J Levy, James H Tabibian
World Journal of Hepatology.2020; 12(6): 262. CrossRef
Endoscopic Ultrasound-Guided Liver Biopsies: Is the Future Here Yet?
Ihab I. El Hajj, Mohammad Al-Haddad
Clinical Endoscopy.2019; 52(4): 297. CrossRef

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Review

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

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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.

Citations

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Primary Pancreatic Natural Killer/T-Cell Lymphoma
Hyung Ku Chon, Keum Ha Choi, Tae Hyeon Kim
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Which Needle Needs to Be Chosen for Better Outcome of Endoscopic Ultrasound-Guided Tissue Acquisition?
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Gut and Liver.2019; 13(3): 223. CrossRef
Successful creation of pancreatic cancer organoids by means of EUS-guided fine-needle biopsy sampling for personalized cancer treatment
Herve Tiriac, Juan Carlos Bucobo, Demetrios Tzimas, Suman Grewel, Joseph F. Lacomb, Leahana M. Rowehl, Satish Nagula, Maoxin Wu, Joseph Kim, Aaron Sasson, Shivakumar Vignesh, Laura Martello, Maria Munoz-Sagastibelza, Jonathan Somma, David A. Tuveson, Elle
Gastrointestinal Endoscopy.2018; 87(6): 1474. CrossRef
Performance of a new histology needle for EUS-guided fine needle biopsy: A retrospective multicenter study
Fabia Attili, Mihai Rimbaş, Alberto Fantin, Carlo Fabbri, Silvia Carrara, Luca Di Maurizio, Giulia Gibiino, Alessandro Repici, Frediano Inzani, Antonio Gasbarrini, Guido Costamagna, Alberto Larghi
Digestive and Liver Disease.2018; 50(5): 469. CrossRef
Esophagus lyomyoma diagnosed with convex endobronchial ultrasound (EBUS)
Paul Zarogoulidis, Stella Laskou, Athanasios Katsaounis, Efstathios Pavlidis, Dimitrios Giannakidis, Charilaos Koulouris, Stylianos Mantalovas, Ioanna Kougioumtzi, Nikolaos Katsikogiannis, Fotis Konstantinou, Wolfgang Hohenforst-Schmidt, Haidong Huang, Ch
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Eun Jeong Gong, Kee Don Choi
Clinical Endoscopy.2016; 49(6): 498. CrossRef
Rapid On-Site Evaluation Does Not Improve Endoscopic Ultrasound-Guided Fine Needle Aspiration Adequacy in Pancreatic Masses: A Meta-Analysis and Systematic Review
Fanyang Kong, Jianwei Zhu, Xiangyu Kong, Tao Sun, Xuan Deng, Yiqi Du, Zhaoshen Li, Giancarlo Troncone
PLOS ONE.2016; 11(9): e0163056. CrossRef
EUS-FNA diagnosis of a rare case of esophageal teratoma
Benedetto Mangiavillano, Antonella De Ceglie, Paolo Quilici, Corrado Ruggeri
Endoscopic Ultrasound.2016; 5(4): 279. CrossRef
Which Needle Is Better for Diagnosing Subepithelial Lesions?
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Clinical Endoscopy.2015; 48(2): 91. CrossRef
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Clinical Endoscopy.2014; 47(5): 371. CrossRef

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Case Report

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

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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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Special Issue Articles of IDEN 2012

Endoscopic Ultrasonography in the Evaluation of Indeterminate Biliary Strictures: Mark Topazian; Clin Endosc 2012;45(3):328-330. Published online August 22, 2012; DOI: https://doi.org/10.5946/ce.2012.45.3.328

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Biliary strictures may be due to a variety of benign and malignant processes. Imaging with endoscopic ultrasonography (EUS) often suggests the diagnosis, but is usually not definitive. EUS-guided fine needle aspiration (FNA) facilitates the diagnosis of extrahepatic biliary strictures, although peritioneal metastases due to needle tract seeding may occur after EUS-FNA of cholangiocarcinoma. In addition to diagnosis of strictures, EUS may play an important role in staging of cholangiocarcinoma.

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Focused Review Series: What Should We Know about EUS-FNA?

Introduction; Value of Endoscopic Ultrasound-Guided Fine Needle Aspiration: Eun Young Kim; Clin Endosc 2012;45(2):115-116. Published online June 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.2.115

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Introduction of endoscopic ultrasound (EUS) to medical practice has brought a huge change in diagnostic algorithm of many gastrointestinal diseases. Addition of EUS-guided fine needle aspiration (FNA) upgraded diagnostic power of EUS. In this focused review series, value of EUS-FNA in the diagnosis of various diseases and tips for getting the best results with EUS-FNA are described by four invited authors including myself. First, Dr. Jeong Seop Moon discussed about EUS-FNA in submucosal lesion. He also touched on basic techniques and needles of EUS-FNA in his article. Next, I focused on additional value of EUS-FNA in the staging of hollow viscus cancer to optimize the treatment strategy. World's well-known endosonographer, Dr. Robert H. Hawes kindly presented his profound thoughts on EUS-FNA in pancreatic cystic lesions. Dr. Jayapal Ramesh and Dr. Shyam Varadarajulu shared their valuable tips for getting the best results when using EUS-FNA. Nobody doubts now EUS-FNA is an indispensable procedure in gastrointestinal endoscopy. Therefore, this focused review series will provide the readers with the concentrated knowledge of "What should we know about EUS-FNA."

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