Experience Of Endosonographer Research Articles

Impact of endoscopist experience, patient age and comorbidities on dose of sedation and sedation-related complications by endoscopic ultrasound.

The aim of the study is to investigate the influence of endosonographer experience and patient-related factors on the dose of sedation and sedation-related complications during endoscopic ultrasound (EUS). Our retrospective analysis included EUS investigations performed between 2015 and 2018 at our institution. Sedation-related complications were defined as cardiorespiratory instability with oxygen saturation drop below 90% or prolonged low blood pressure or bradycardia. In total, 537 EUS examinations were analyzed (37.3% interventional). The median dose of propofol and midazolam were: 140 (30-570) and 3(1-7) mg, respectively. Sedation-related complications were documented in 1.8% of cases. All patients had transient, nonfatal respiratory insufficiency. Totally, 60% of the patients who developed complications were >75 years and 70% were male. The presence of cardiac and/or pulmonary comorbidities was associated with an OR = 8.77 [95% confidence interval (CI), 1.8-41.7] and American Society of Anesthesiologists class III with an OR = 7.64 (95% CI, 1.60-36.3) for the occurrence of sedation-related complications. Endosonographer experience did not influence the rate of sedation-related complications. In both diagnostic and interventional EUS, patients with comorbidities and older age received significantly less sedation. Experienced endosonographers used less sedation than trainees. Endosonographer experience, patient age and the presence of comorbidities had a significant influence on sedation dose. Sedation-related complications occurred only in 1.8% of cases.

Prospective study of EUS-guided tissue acquisition with a 20G core biopsy needle with a forward bevel for solid pancreatic mass.

There is a growing need for tissue collection for immunostaining and genetic testing. Recently, several fine-needle biopsy needles are commercially available for endoscopic ultrasound-guided tissue acquisition.This prospective historical controlled study evaluates a 20G core biopsy needle with a forward bevel for solid pancreatic masses larger than 15 mm in diameter. The primary endpoint was the accuracy of histological diagnosis. The secondary endpoints included technical success rate, sample adequacy for histology, cytological diagnostic accuracy, and adverse events.Seventy consecutive patients were enrolled between January and October 2017. We achieved technical success in all cases regardless of the puncture sites or the endosonographer's experience. The final diagnoses were neoplasms in 67 patients (95.7%; pancreatic cancer in 65 patients, neuroendocrine neoplasm in 1, and malignant lymphoma in 1) and benign lesions in 3 patients (4.3%; autoimmune pancreatitis in 2 patients and mass-forming pancreatitis in 1). The obtained specimens were adequate for histological evaluation in all cases and the histological accuracy was 91.4% (95% confidence interval, 82.3–96.8%, P < .05) with the sensitivity and specificity of 91.0% and 100%, respectively. The cytological diagnostic accuracy was 95.7% and all patients were accurately diagnosed by combining cytological and histological examinations. As for adverse events, an asymptomatic needle fracture occurred in 1 case (1.4%).This 20G core biopsy needle with a forward bevel showed a high accuracy of histological diagnosis for solid pancreatic masses.

Application of Endoscopic Ultrasonography in the Diagnosis and Treatment of Lower Gastrointestinal Disease

Application of Endoscopic Ultrasonography in the Diagnosis and Treatment of Lower Gastrointestinal Disease

Which needle is better for diagnosing subepithelial lesions?

Which needle is better for diagnosing subepithelial lesions?

Clinical factors associated with accuracy of EUS-FNA for pancreatic or peripancreatic solid mass without on-site cytopathologists.

Endoscopic ultrasound-guided fine needle aspiration (EUSFNA) is a safe and effective technique for tissue diagnosis in patients with pancreatic or peripancreatic solid masses. However, the procedure is difficult to accomplish without an on-site cytopathologist. The aims of this study were to examine the outcomes of EUS-FNA for pancreatic or peripancreatic solid masses without an on-site cytopathologist and to determine the factors associated with diagnostic accuracy. From December 2005 to November 2011, 230 patients with pancreatic or peripancreatic solid masses had 240 EUS-FNAs performed without an on-site cytopathologist. The medical records of the 230 patients from a single tertiary center were retrospectively reviewed. Among the 230 patients who underwent EUS-FNA, 201 patients (88%) had malignancy, which included 171 adenocarcinomas (74%). Assuming that the cytopathological malignancy was positive or suspicious for malignant cells with cytology, the accuracy without an on-site cytopathologist was 67.9%. However, the accuracy increased from 40.0% for the first 30 cases (from 2006 to 2008) to 83.3% for the last 30 cases (in 2011) and was constantly over 80.0% starting from the sixth octile onwards for every 30 cases (in 2011). From the analysis of factors associated with the accuracy of the diagnosis using logistic regression analysis, the number of needle passes and the experience of endosonographer were statistically associated with the diagnostic accuracy. In the case of performing EUS-FNA for pancreatic or peripancreatic solid masses without an on-site cytopathologist, the experience of the endosonographer, and the number of needle passes were associated with the diagnostic accuracy.

Fine-needle biopsy: should this be the first choice in endoscopic ultrasound-guided tissue acquisition?

Endoscopic ultrasound (EUS)-guided tissue acquisition is an indispensable technique for the diagnosis of many diseases of the gastrointestinal tract and adjacent structures. EUS-guided fine-needle aspiration (EUS-FNA) is known for its high accuracy and low complication rate. However, the outcome of EUS-FNA highly depends on several factors such as the location and characteristics of the lesion, endosonographer's experience, technique of sampling and sample preparation, type and size of the needle used, and presence of a cytopathologist for rapid on-site examination. EUS-guided fine-needle biopsy is useful to obtain core tissue samples with relatively fewer passes. Aspiration of core tissue with preserved architecture is beneficial for the diagnosis of certain diseases and the performance of ancillary testing such as tumor molecular profiling. Issues related to needle size, type, and their acquired samples for cytologic and histologic evaluation are discussed here.

Diagnosis of Subepithelial Lesion: Still "Tissue Is the Issue"

Diagnosis of Subepithelial Lesion: Still "Tissue Is the Issue"

PTU-081 Endoscopic ultrasound-guided fine needle aspiration of solid pancreatic lesions: an observational study: Abstract PTU-081

<h3>Introduction</h3> Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic lesions is a valuable tool in the investigation of suspected pancreatic cancer. Recent international studies on the diagnostic utility of this technique have reported sensitivity and accuracy levels of &gt;90%. There is a paucity of UK centre data on diagnostic performance. In this retrospective observational study we aim to report the largest UK cohort and provide comparison with international standards. <h3>Methods</h3> Hammersmith Hospital is a regional pancreatobiliary referral centre. A single experienced endosonographer provides all diagnostic and therapeutic EUS services. A retrospective analysis of patients who underwent EUS-FNA for solid pancreatic lesions between Jan 2006 and Oct 2009 was performed. Cytopathology reports for cases were scrutinised. Cytological diagnosis was compared with the reference standard of surgical or biopsy histology, clinical and radiological evidence of disease progression, or in the case of benign cytology a minimum of 6 months clinical follow-up. <h3>Results</h3> A total of 113 EUS-FNAs for a solid pancreatic lesion were identified during the study period (average age 66 years, M/F ratio 1.1:1). The final outcomes were: pancreatic carcinoma (87/113, 77%), benign disease or pancreatitis (18/113, 16%) neuroendocrine tumour (5/113, 4%), metastasis (2/113, 1.7%), lymphoma (1/113, 0.8%). 15/113 cytology specimens were graded as “C4” or “highly suspicious of adenocarcinoma”, and in all the final diagnosis was pancreatic adenocarcinoma (PPV 100%). Performance characteristics were calculated both considering the C4/suspicious specimens as false negatives for malignancy and true positives (Abstract 081). Comparing the performance of EUS-guided FNA in years 2006–2007 to years 2008–2009 there was an improvement in sensitivity (78% to 92%) and accuracy (82% to 93%), respectively. <h3>Conclusion</h3> In solid pancreatic lesions FNA specimens classified cytologically as C4 have a 100% PPV for adenocarcinoma and should be considered diagnostic for this. The performance of EUS-FNA of solid pancreatic lesions in our institution, a UK regional referral centre, is comparable to international standards. A recent improvement in sensitivities and accuracy to in excess of 90% was noted. Further endosonographer experience, better case selection and routine use of “in-room” cytopathologist support may account for this and should be considered as strategies to improve accuracy further.

Accuracy of EUS in Differentiating Mucosal versus Submucosal Superficial Esophageal Lesions: A Systematic Review and Meta-analysis

Purpose: Background: Endoscopic techniques including photodynamic therapy, laser photoablation, contact thermal coagulation, and endoscopic mucosal resection (EMR) offer minimally invasive treatment options for esophageal lesions limited to the mucosa but not with submucosal invasion. The discrimination of truly superficial from more advanced lesions is thus critical to the selection of patients for endoscopic therapy. EUS provides the most accurate method to stage esophageal carcinoma (EC). Aim: To perform a systematic review and meta-analysis for assessing the sensitivity, specificity, and likelihood ratios (LR) of EUS in differentiating mucosal (T1a) from submucosal (T1b) EC. Methods: MEDLINE, SCOPUS, Cochrane, and CINAHL Plus databases were used to identify studies in which results of EUS based staging of EC were compared with the results of an acceptable standard, including histopathology of EMR or surgically resected lesions. Two independent reviewers extracted standardized data. DerSimonian-Liard random effects model was used to estimate the pooled sensitivity, specificity, and LR. A summary receiver operating characteristic (ROC) curve was constructed. All potential sources of heterogeneity amongst the studies were explored by subgroup and meta-regression analyses. Results: 702 patients with EUS-based staging of EC were examined from 10 prospective studies that satisfied our inclusion criteria. The pooled sensitivity and specificity of EUS in staging mucosal lesions were 0.88 (95% CI, 0.84-0.92) and 0.83 (95% CI, 0.78-0.88). In contrast, for submucosal lesions the pooled sensitivity and specificity were 0.83 (95% CI, 0.77-0.87) and 0.88 (95% CI, 0.84-0.91). The positive and negative LR for mucosal staging were 5.20 (95% CI, 2.43-11.15) and 0.18 (95% CI, 0.10-0.31) and for submucosal staging were 5.60 (95% CI, 3.18-9.87) and 0.19 (95% CI, 0.09-0.40), respectively. The area under the curve (AUC) was 0.93 for both mucosal and submucosal lesions. The P value of X2 heterogeneity for all the pooled estimates was >0.05 suggesting significant heterogeneity amongst the studies. Heterogeneity is probably caused by factors that were inadequately reported in primary studies and, therefore, could not be explored in this meta-analysis. Conclusion: Overall EUS has good accuracy (AUC 0.93) in staging superficial esophageal cancers. However, despite the advances in endoscopic ultrasound techniques preoperative staging between mucosal and submucosal invasion remains challenging. Significant heterogeneity among the included studies suggests that multiple factors including location and type of lesion, method and frequency of EUS probe and experience of endosonographer can affect diagnostic accuracy of EUS.