929 A Prospective Evaluation of a Novel Ultra-Slim Echoendoscope for EUS-Guided FNA, FNB and Celiac Plexus Neurolysis

Abstract

INTRODUCTION: Safe and successful EUS and EUS-guided interventions rely on the ability to reach the intended organ reliably and safely. Possible barriers include altered anatomy, stenosis in the GI tract, or low BMI, making the current echoendoscopes hazardous to use. Therefore, we prospectively evaluated the utility of a novel Ultra-Slim echoendoscope in these challenging scenarios. METHODS: We prospectively enrolled 25 patients in this study. Criteria for inclusion were as follows: Weight less than 120 lbs, children, mediastinal lymph nodes with severe lung disease or sleep apnea, altered anatomy, and esophageal stenosis precluding the passage of the standard echoendoscope. The Ultra-Slim echoendoscope (EG-3270UK: Pentax, Montvale, NJ USA) was utilized in all cases. A 22-gauge FNA or FNB needle were utilized. A fenestrated 20-gauge needle was used for CPN. Complications were assessed at 30 days as we previously described. RESULTS: A total of 25 patients were included in this study with a mean age of 69.16 years (standard deviation of 13.5). Females accounted for 64% of the study population. Indications for EUS use were: 64% (n = 16) had an abnormal CT or PET scan, 4% (n = 1) had MLN, 24% (n = 6) had a pancreatic mass, 8% (n = 2) had other indications. Reasons for using the Ultra-slim echoendoscope were: 28% of patients (n = 7) had low body weight defined as less than or equal to 120 lbs, 12% (n = 3) had MLN, 32% (n = 8) had altered anatomy and 28% (n = 7) had esophageal stenosis. Of the 25 Ultra-slim procedures performed, an FNA biopsy was taken 68% of the time (n = 17) while in 32% (n = 8) a biopsy was not performed. Of those 17 biopsies taken, a 22G FNA needle was used 87.5% (n = 14) of the time, and the FNB 19G needle was used 12.5 % (n = 2). Targets for biopsy were MLN 56.25% (n = 9), Adrenal Gland 6.25% or (n = 1), Liver 18.75% (n = 3), Pancreas 12.5% (n = 2) or Other 6.25% (n = 1). CPN was performed 3 times or 12% of procedures. Of the 17 samples taken, 65 % (n = 11) were malignant while 35% (n = 6) were benign. The average size of target biopsied was 32.8 mm × 25.2 mm (standard deviation 14.18 × 12.9) with a range of 11-73 mm and 8-65 mm. No immediate or long-term complications occurred. CONCLUSION: An ultra-slim echoendoscope is very useful and may be better tolerated in individuals with low body weight, altered anatomy and stenosis in the GI track and in patients with lung cancer. Further modifications are warranted to allow more therapeutic interventions with this important addition to the endosonographer daily armamentarium.