Forward-viewing versus oblique-viewing echoendoscopes in the diagnosis of upper GI subepithelial lesions with EUS-guided FNA: a prospective, randomized, crossover study - 28/05/16

Doi : 10.1016/j.gie.2014.12.051

Ippei Matsuzaki, MD ¹, Ryoji Miyahara, MD, PhD ^1,^⁎, Yoshiki Hirooka, MD, PhD ², Kohei Funasaka, MD, PhD ², Eizaburo Ohno, MD, PhD ¹, Masanao Nakamura, MD, PhD ¹, Hiroki Kawashima, MD, PhD ¹, Akiko Nukaga, MD, PhD ³, Yoshie Shimoyama, MD, PhD ³, Hidemi Goto, MD, PhD ^1,²
¹ Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
² Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
³ Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya, Japan

^∗Reprint requests: Ryoji Miyahara, PhD, Department of Gastroenterology, Nagoya University Graduate School of Medicine, 65, Tsuruma-cho, Showa-ku, Nagoya, 466-8550 Japan.

Abstract

Background

The role of the forward-viewing echoendoscope compared with the oblique-viewing echoendoscope for EUS-guided FNA (EUS-FNA) of upper GI subepithelial lesions has not been defined.

Objective

To compare the diagnostic yield and clinical efficacy of EUS-FNA by using the 2 echoendoscopes in the same upper GI subepithelial lesion.

Design

Prospective, randomized, crossover study.

Setting

Tertiary-care medical center.

Patients

Forty-one patients with an upper GI subepithelial lesion.

Interventions

All patients first underwent EUS-FNA with a 19-gauge needle by using both echoendoscopes, based on random selection. When required, 22-gauge or 25-gauge needles were used additionally.

Main Outcome Measurements

Comparison of diagnostic yield, tissue sample area, puncture success rates, procedure time, and adverse events.

Results

Forty-one patients (median lesion size 22 mm, range 15-63 mm) were enrolled. Rates of histologic diagnosis were 80.5% (33/41) and 73.2% (30/41) (P = .453) by using forward-viewing and oblique-viewing echoendoscopes, respectively. Median tissue sample area in GI stromal tumors (n = 22) obtained with the forward-viewing echoendoscope was larger than with the oblique-viewing echoendoscope (2.46 mm² vs 1.00 mm²; P = .046). Puncture success rates were 39 of 41 (95.1%) and 35 of 41 (85.4%; P = .289) with forward-viewing and oblique-viewing echoendoscopes, respectively. Median procedure time was 21 minutes with the forward-viewing echoendoscope and 27 minutes with the oblique-viewing echoendoscope (P = .009). An infectious adverse event occurred in a patient and was treated with antibiotics.

Limitations

Small sample size.

Conclusion

Diagnostic yield did not differ between the 2 echoendoscopes. However, tissue sample area and procedure time were superior with the forward-viewing echoendoscope.

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Abbreviations : EUS-FNA, GIST

Plan

Patients and methods

Equipment

Echoendoscope

Forward-viewing echoendoscope

FNA needle

EUS-FNA procedure

Histologic assessment

Outcome measures

Primary endpoint: diagnostic yield

Secondary endpoints: clinical efficacy

Statistical analysis

Results

Discussion

DISCLOSURE: Olympus Medical Systems loaned the forward-viewing echoendoscope for the study. All authors disclosed no financial relationships relevant to this article.