Ippei Matsuzaki1, Ryoji Miyahara1, Yoshiki Hirooka2, Kohei Funasaka2, Eizaburo Ohno1, Masanao Nakamura1, Hiroki Kawashima1, Akiko Nukaga3, Yoshie Shimoyama3, Hidemi Goto4. 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. 4. Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Endoscopy, Nagoya University Hospital, Nagoya, 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.
RCT Entities:
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.