3464 Eus guided fine needle aspiration biopsy with a new electronic device: results on 100 consecutive patients.

Abstract

We have previously demonstrated that on an intention-to-biopsy basis, EUS-FNAB in solid pancreatic tumours results in an cyto/histological diagnosis in 70 % of cases. Reasons for failure often stem from inability to penetrate lesions which are located in unfavorable areas such as the pancreatic head and uncinate process. Aim : To evaluate the feasability, efficacy and complication rate of EUS-FNAB using the new convex echo-endoscope Olympus GF UC 30 P. Methods : This device produces saggittal views of 180° has an operating channel of 2,8 mm (compared to 120° and 2 or 2.4 mm for the conventional linear scopes, respectively) and has a bridge which can alter the angle of exit of the 6 cm 22 G needle. EUS-FNAB was considered feasible by the ability to position the needle in the target, thus allowing biopsy. The biopsy was considered effective when the specimen was adequate for analysis from a cyto-histological (solid tumours) and a biochemical/cytological (pancreatic cystic lesions) point of view. Efficacy was calculated as a percentage of satisfactory specimens in relation to the number of successful biopsies and on the intention-to-biopsy i.e., of all lesions biopsied. Results : 114 EUS-FNAB were performed in 100 consecutive patients during one year. Overall feasability was 98 % with an efficacy rate of 95 % in successful biopsies and 93 % on intention-to-biopsy. The tumours included 35 pancreatic solid lesions (uncinate process 7, head 17, mean diameter : 32 mm). A single case of failed biopsy occurred : feasability = 97 %. The efficacy was 91 % on successful biopsies and 89 % on intention-to-biopsy. There were 30 cystic pancreatic lesions (head : 16, mean diameter : 23 mm) and puncture was feasible in 97 %. Cyto-histological and biochemical analyses were possible in 20 and 23 of the 29 cases respectively. A combination of biochemical and histological studies yielded an efficacy rate of 97 % in successful biopsies and 93 % on intention-to-biopsy. Other lesions types included 13 digestive wall or juxta-parietal lesions. The feasability was 100 % and the efficacy was 85 %. All 33 lymph nodes were biopsied successfully (feasability 100 %). The efficacy was 97 %. Three hepatic masses were biopsied (feasability and efficacy : 100 %). Moderate pancreatitis occurred in 2 patients. Conclusion : This new device compares favourably with the results using conventional electronic devices, particularly regarding solid pancreatic head tumours.