Clin Endosc.  2023 May;56(3):367-374. 10.5946/ce.2021.238.

Utility of forward-view endoscopic ultrasound in fine-needle aspiration in patients with a surgically altered upper gastrointestinal anatomy

• Bakr A
• Hara K
• Elshair M
• Haba S
• Kuwahara T
• Okuno N
• Fumihara D
• Yanaidani T
• Zaky S
• Omar H

• KMID: 2542464
• DOI: http://doi.org/10.5946/ce.2021.238

Abstract

Background/Aims
Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) using oblique-view EUS in patients with a surgically altered anatomy (SAA) of the upper gastrointestinal tract is limited because of difficult scope insertion due to the disturbed anatomy. This study aimed to investigate the efficiency of forward-view (FV)-EUS in performing FNA in patients with a SAA.
Methods
We retrospectively investigated 32 patients with a SAA of the upper gastrointestinal tract who visited Aichi Cancer Center Hospital in Nagoya, Japan, between January 2014 and December 2020. We performed-upper gastrointestinal EUS-FNA using FV-EUS combined with fluoroscopic imaging to confirm tumor recurrence or to make a decision before chemotherapy or after a failure of diagnosis by radiology.
Results
We successfully performed EUS-FNA in all studied patients (100% technical success), with the specificity, sensitivity, and accuracy of 100%, 87.5%, and 87.8%, respectively, with no complications.
Conclusions
EUS-FNA using FV-EUS combined with fluoroscopic imaging is an effective and safe technique for tissue acquisition in patients with a SAA.

Keyword

Endoscopic ultrasound-guided fine needle aspiration; Forward-viewing Endoscopic ultrasound; Surgical altered anatomy

Figure

• 

  Fig. 1. (A) Oblique-view endoscopic ultrasound scope with maximum angulation in retroflexion with the use of an elevator. It is usually difficult to advance the needle in this position. (B) Forward-view endoscopic ultrasound scope in full retroflexion with no elevator. Note that this position facilitates smooth needle advancement compared with oblique-view endoscopic ultrasound. Courtesy of Prof. Pietro Fusaroli at the University of Bologna, Italy. Endosc Ultrasound 2013;2:64–70.9

• 

  Fig. 2. (A) Forward-view endoscopic ultrasound image showing lymph node swelling around the hepatic hilum and the needle inserted inside the lesion for fine-needle aspiration. (B) Forward-view endoscopic ultrasound image showing lymph node swelling around the portal vein and the needle inserted inside the lesion for fine-needle aspiration.

• 

  Fig. 3. Tip of the forward-view endoscopic ultrasound scope under fluoroscopy, passing through the afferent loop toward the lesion.

• 

  Fig. 4. Picture of the detachable cap (endoscopic distal attachment cap; Olympus Medical Systems).

• 

Reference

1. Vilmann P, Jacobsen GK, Henriksen FW, et al. Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease. Gastrointest Endosc. 1992; 38:172–173.

2. Yamao K, Sawaki A, Mizuno N, et al. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB): past, present, and future. J Gastroenterol. 2005; 40:1013–1023.

3. Fusaroli P, Kypraios D, Caletti G, et al. Pancreatico-biliary endoscopic ultrasound: a systematic review of the levels of evidence, performance and outcomes. World J Gastroenterol. 2012; 18:4243–4256.

4. Mortensen MB, Pless T, Durup J, et al. Clinical impact of endoscopic ultrasound-guided fine needle aspiration biopsy in patients with upper gastrointestinal tract malignancies. A prospective study. Endoscopy. 2001; 33:478–483.

5. Katanuma A, Hayashi T, Kin T, et al. Interventional endoscopic ultrasonography in patients with surgically altered anatomy: techniques and literature review. Dig Endosc. 2020; 32:263–274.

6. Hara K, Okuno N, Haba S, et al. How to perform EUS-guided hepaticogastrostomy easier and safer. J Hepatobiliary Pancreat Sci. 2020; 27:563–564.

7. Elshair M, Hara K, Kuwahara T, et al. Utility of stent-in-stent technique in management of post-pancreatitis splenic abscess using forward-viewing echoendoscope. J Hepatobiliary Pancreat Sci. 2021; 28:e40–e41.

8. Imaizumi H, Irisawa A. Preliminary experience of a prototype forward-viewing curved linear array echoendoscope in a training phantom model. Dig Endosc. 2010; 22(Suppl 1):S123–S127.

9. Fusaroli P, Ceroni L, Caletti G, et al. Forward-view endoscopic ultrasound: a systematic review of diagnostic and therapeutic applications. Endosc Ultrasound. 2013; 2:64–70.

10. Haba S, Yamao K, Bhatia V, et al. Diagnostic ability and factors affecting accuracy of endoscopic ultrasound-guided fine needle aspiration for pancreatic solid lesions: Japanese large single center experience. J Gastroenterol. 2013; 48:973–981.

11. Unno J, Kanno A, Masamune A, et al. The usefulness of endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of pancreatic neuroendocrine tumors based on the World Health Organization classification. Scand J Gastroenterol. 2014; 49:1367–1374.

12. Polkowski M, Jenssen C, Kaye P, et al. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guide­line - March 2017. Endoscopy. 2017; 49:989–1006.

13. Stelow EB, Debol SM, Stanley MW, et al. Sampling of the adrenal glands by endoscopic ultrasound-guided fine-needle aspiration. Diagn Cytopathol. 2005; 33:26–30.

14. Larghi A, Ibrahim M, Fuccio L, et al. Forward-viewing echoendoscope versus standard echoendoscope for endoscopic ultrasound-guided tissue acquisition of solid lesions: a randomized, multicenter study. Endoscopy. 2019; 51:444–451.

15. Wilson JA, Hoffman B, Hawes RH, et al. EUS in patients with surgically altered upper GI anatomy. Gastrointest Endosc. 2010; 72:947–953.

16. Tanaka K, Hayashi T, Utsunomiya R, et al. Endoscopic ultrasound-guided fine needle aspiration for diagnosing pancreatic mass in patients with surgically altered upper gastrointestinal anatomy. Dig Endosc. 2020; 32:967–973.

17. Fusaroli P, Serrani M, Lisotti A, et al. Performance of the forward-view echoendoscope for pancreaticobiliary examination in patients with status post-upper gastrointestinal surgery. Endosc Ultrasound. 2015; 4:336–341.

18. Thinrungroj N, Hara K, Mizuno N, et al. Utility of forward-view echoendoscopy for transcolonic fine-needle aspiration of extracolonic lesions: an institutional experience. Clin Endosc. 2020; 53:60–64.

19. Brozzi L, Petrone MC, Poley JW, et al. Outcomes of biliopancreatic EUS in patients with surgically altered upper gastrointestinal anatomy: a multicenter study. Endosc Int Open. 2020; 8:E869–E876.