New curved linear echoendoscope for endoscopic ultrasonography-guided fine-needle aspiration in patients with Roux-en-Y reconstruction (with videos).

Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) is an established technique for various pancreatic lesions. However, Roux-en-Y reconstruction (RY) is sometimes considered a relative contraindication of EUS-FNA.[1] Here, we present two successful cases of EUS-FNA using a new curved linear echoendoscope (CLE) in patients with RY.

Case 1: A 72-year-old man was admitted after total gastrectomy with RY for gastric cancer 10 years prior. Computed tomography (CT) revealed a low-density mass in the tail of the pancreas. EUS-FNA with standard CLE (GF-UCT260-AL5, Olympus, Tokyo, Japan) was attempted but failed to reach the afferent limb because of acute angulation. Instead, a new CLE (EG-580UT, Fujifilm, Tokyo, Japan) was carefully advanced to the afferent limb [Figure 1]. Pancreatic mass was well visualized, following successful and uneventful EUS-FNA using 22-gauge needle [Video 1].

Figure 1

A new curved linear echoendoscope (EG-580UT, Fujifilm, Tokyo, Japan) with frontal endoscopic view and flexible scope tip which enables a safe and reliable intubation

Case 2: A 65-year-old man with a history of total gastrectomy and RY for gastric cancer 13 years prior was admitted. CT revealed a low-density mass with pseudocyst in the tail of the pancreas. After failed insertion of standard CLE, the new CLE was successfully advanced to the afferent limb. Subsequently, EUS-FNA was performed using 20-gauge needle without any complication [Video 2].

The majority of EUSs including FNAs are able to have a complete examination, if could reach the afferent limb even in cases of RY.[1] Low flexibility and low maneuverability due to restricted frontal endoscopic view of the standard echoendoscope make it challenging to reach the afferent limb.[23] Recently, a forward-viewing echoendoscope has become available, however, the EUS view is quite narrow compared to the standard CLE. The new CLE has improved frontal endoscopic view and flexible scope tip [Figure 2]. Therefore, the new CLE enables a safe and reliable intubation, which might allow successful procedures for surgically altered anatomy.

Figure 2

Scope tip comparison between a new curved linear echoendoscope (EG-580UT; FUJIFILM, Tokyo, Japan; the front side) and standard curved linear echoendoscope (GF-UCT260-AL5; Olympus, Tokyo, Japan; the back side) both with the maximum angulation up position

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.