Endoscopic ultrasound-guided transvascular needle biopsy of thoracic and abdominal lesions: a multicenter experience.

Published on Nov 27, 2020in Endoscopy International Open
· DOI :10.1055/A-1288-0030
Albert Garcia-Sumalla2
Estimated H-index: 2
(University of Barcelona),
Jose Carlos Subtil15
Estimated H-index: 15
+ 6 AuthorsJoan B. Gornals15
Estimated H-index: 15
(University of Barcelona)
Sources
Abstract
Background and study aims Traditionally in the case of a vascular interposition, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been contraindicated. A transvascular route (TV) is feasible and probably a safe alternative approach in selected patients, but data are scarce. The primary aim of this study was to analyze the diagnostic yield and safety of EUS-TV-FNA in thoracic and abdominal lesions. Secondary aims included evaluation of the clinical impact and technical aspects. Patients and methods A retrospective multicenter study was conducted with inclusion of all consecutive patients that underwent EUS-TV-FNA from July 2007 to January 2020. Feasibility, cytopathology, procedure details, and safety were evaluated. Univariate analysis was performed to identify variables associated with incidents, cytopathological diagnosis, and clinical impact. Results Data were collected from a total of 49 cases and 50 EUS-TV-FNAs. The aorta (n = 19) and portal system (n = 17) were the most frequently punctured. The most frequent lesions were mediastinal lymph nodes (n = 13) and pancreatic tumors (n = 11). The diagnostic yield was 86 %, and there were nondiagnostic samples in seven cases. Overall sensitivity, specificity, and accuracy were 88 % (95 %CI,0.74–0.96), 100 % (95 %CI,0.59–1), and 90 % (95 %CI,0.78–0.96), respectively. Only three incidents were detected: two mural hematomas and a self-limited bleeding of gastroduodenal artery. In most patients, there was a significant impact on clinical management (88 %). Arterial vessel and ASA-III had a trend with incidents (both, P  Conclusions EUS-TV-FNA is feasible, seems to be safe, and can be recommended when no other targets are available, and the information obtained would impact on the clinical plan.
References20
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#1Juan Carlos Molina (UdeM: Université de Montréal)H-Index: 3
#2Fawad Chaudry (UdeM: Université de Montréal)H-Index: 1
Last. Moishe Liberman (UdeM: Université de Montréal)H-Index: 30
view all 8 authors...
Abstract Objectives Endoscopic ultrasound-guided biopsies including EBUS-TBNA and EUS-FNA are currently standard of care for the assessment of mediastinal lymphadenopathy. Traditionally, passing the needle through and through vascular structures has been avoided due to bleeding risk. The objective is to evaluate the safety and diagnostic accuracy of transvascular endosonographic-guided biopsies of mediastinal, hilar and lung lesions. The hypothesis is that the approach is safe and adds to the en...
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#1Min Wang (Nanjing Medical University)H-Index: 19
#2Shu HuangH-Index: 1
Last. Xiujiang Yang (Fudan University)H-Index: 1
view all 5 authors...
Background: Endoscopic ultrasonography guided fine needle aspiration (EUS-FNA) is a well-established technique for diagnosing pancreatic malignancy. In general, tissue of pancreatic head and uncinate process lesions is obtained via a transduodenal approach. However, this tissue-acquisition modality is not applicable in cases of pyloric obstruction and duodenal bulb ulceration. The aim of this study is to determine the feasibility and safety of a novel EUS-guided transgastric trans-portal system ...
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#1Christopher G. Chapman (U of C: University of Chicago)H-Index: 13
#2Irving Waxman (U of C: University of Chicago)H-Index: 46
EUS provides real-time images of the intramural gastrointestinal tract and adjacent structures that otherwise would not be visible. Given the anatomic proximity to the bowel, accurate identification of the major abdominal vasculature, such as the portal vein, serves as a useful landmark tool for identifying anatomy and staging of malignancies. Recently, increased reports have centered on the utility of EUS-guided vascular access of the portal vein for diagnostic and therapeutic interventions. Pi...
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#1Ravindra M Mehta (Apollo Hospitals)H-Index: 9
#2Pavankumar Biraris (Apollo Hospitals)H-Index: 1
Last. Michael CutaiaH-Index: 11
view all 7 authors...
BACKGROUND:Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) has revolutionized the diagnostic approach to mediastinal diseases. Lesions located lateral to the pulmonary artery (trans-PA, Station 5), or in the lumen of the PA (intra-PA) are in the 'blind-spot' of EBUS. OBJECTIVES:We describe a case series where EBUS guided trans-pulmonary or intra-pulmonary aspiration (EBUS-TIPNA) was used for diagnosis. METHODS:Retrospective analysis of 10 patients who had EBUS-TIPNA ...
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#1Rajat Garg (UNM: University of New Mexico)H-Index: 1
#2Tarun RustagiH-Index: 22
Endoscopic ultrasound (EUS) has evolved from a purely diagnostic to an interventional modality offering minimally invasive alternatives to surgical and radiologic interventions. This has led to a rapidly growing interest in EUS-guided vascular interventions. EUS-guided portal venous access is an emerging technique which opens a new arena for interventional vascular EUS. Portal vein can be accessed under EUS guidance with high precision and low risk of complications thus expanding its application...
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#1Guru TrikudanathanH-Index: 20
#2Rahul PannalaH-Index: 24
Last. John T. MapleH-Index: 45
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#1Jordan Kazakov (UdeM: Université de Montréal)H-Index: 10
#2Pravachan Hegde (UdeM: Université de Montréal)H-Index: 4
Last. Moishe Liberman (UdeM: Université de Montréal)H-Index: 30
view all 6 authors...
Background Endoscopic techniques, including endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS), are the initial approach for the diagnosis and staging of lung cancer and the diagnosis of mediastinal and hilar lesions. Historically, the transvascular approach has been avoided because of concerns of bleeding. Here we review our experience with EBUS and EUS transvascular biopsy of mediastinal, hilar, and lung lesions. Methods A prospective research database was used to retrospectively ...
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#1Nah Kyum Lee (UOU: University of Ulsan)H-Index: 1
#2Shinhee Park (UOU: University of Ulsan)H-Index: 2
Last. Do Hyun ParkH-Index: 69
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#1Domenico Galasso (CUA: The Catholic University of America)H-Index: 13
#2Mihai RimbasH-Index: 9
Last. Alberto Larghi (CUA: The Catholic University of America)H-Index: 32
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#1Filippo LococoH-Index: 23
#2Fabia Attili (CUA: The Catholic University of America)H-Index: 16
Last. Alberto Larghi (CUA: The Catholic University of America)H-Index: 32
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Cited By3
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Last. Manuel Perez-MirandaH-Index: 24
view all 5 authors...
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