Koichiro Tsutsumi1,2, Toru Ueki3, Yasuhiro Noma4, Kunihiro Omonishi5, Kyotaro Ohno5, Soichiro Kawahara3, Takashi Oda3, Hironari Kato6, Hiroyuki Okada6. 1. Departments of Internal Medicine, Fukuyama City Hospital, 5-23-1, Zao-cho, Fukuyama-City, Hiroshima, 721-8511, Japan. tsutsumi@cc.okayama-u.ac.jp. 2. Department of Gastroenterology and Hepatology, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama-City, Okayama, 700-8558, Japan. tsutsumi@cc.okayama-u.ac.jp. 3. Departments of Internal Medicine, Fukuyama City Hospital, 5-23-1, Zao-cho, Fukuyama-City, Hiroshima, 721-8511, Japan. 4. Department of Internal Medicine, National Hospital Organization Fukuyama Medical Center, 4-14-17, Okinogami-cho, Fukuyama-City, Hiroshima, 720-8520, Japan. 5. Departments of Internal Medicine and Pathology, Fukuyama City Hospital, 5-23-1, Zao-cho, Fukuyama-City, Hiroshima, 721-8511, Japan. 6. Department of Gastroenterology and Hepatology, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama-City, Okayama, 700-8558, Japan.
Abstract
BACKGROUND: The histological diagnosis of autoimmune pancreatitis (AIP) by an endoscopic ultrasound (EUS)-guided approach is still challenging. METHODS: We investigated the utility of the 21-gauge Menghini-type biopsy needle with the rolling method for the histological diagnosis of AIP, in comparison with conventional 22-gauge needles. Among total 28 patients, rate of definitive histological diagnosis, acquired sample area of tissue, rate of histopathological diagnosis of AIP, and adverse events were retrospectively analyzed. RESULTS: Definitive histological diagnoses were successfully accomplished in all 14 patients (100%) treated with a Menghini-type needle, and in 57% of cases (8/14) treated with conventional 22-gauge needles (P < 0.001). The median sample area of the tissue, except for blood contamination, was remarkably larger by the Menghini-type needle than by conventional-type needles (6.2 [IQR, 4.5-8.8] versus 0.7 [IQR, 0.2-2.0] mm2, P < 0.001), and the area per punctures was approximately 4 times larger (1.4 [IQR: 0.9-2.9] versus 0.3 [IQR: 0.1-0.6] mm2/puncture, P < 0.001). Based on the International Consensus Diagnostic Criteria, lymphoplasmacytic infiltration, abundant IgG4-postive cells, storiform fibrosis, and obliterative phlebitis were found in 86%/29%, 64%/0%, 36%/0%, and 7%/0% patients who were treated with the Menghini-type needle and conventional-type needles, respectively. Consequently, histopathological diagnosis with type 1 AIP (lever 1 or 2) was achieved in 9 patients (64%) treated with the Menghini-type needle and in no patient treated with conventional-type needles (P < 0.001). Two patients who had mild post-procedural pancreatitis improved with conservative treatment, and no bleeding occurred in patients treated with the Menghini-type needle. CONCLUSION: EUS-guided rolling method with the 21-gauge Menghini-type biopsy needle is useful for the histopathological diagnosis of AIP, due to its abundant acquisition of good-quality tissue from the pancreas.
BACKGROUND: The histological diagnosis of autoimmune pancreatitis (AIP) by an endoscopic ultrasound (EUS)-guided approach is still challenging. METHODS: We investigated the utility of the 21-gauge Menghini-type biopsy needle with the rolling method for the histological diagnosis of AIP, in comparison with conventional 22-gauge needles. Among total 28 patients, rate of definitive histological diagnosis, acquired sample area of tissue, rate of histopathological diagnosis of AIP, and adverse events were retrospectively analyzed. RESULTS: Definitive histological diagnoses were successfully accomplished in all 14 patients (100%) treated with a Menghini-type needle, and in 57% of cases (8/14) treated with conventional 22-gauge needles (P < 0.001). The median sample area of the tissue, except for blood contamination, was remarkably larger by the Menghini-type needle than by conventional-type needles (6.2 [IQR, 4.5-8.8] versus 0.7 [IQR, 0.2-2.0] mm2, P < 0.001), and the area per punctures was approximately 4 times larger (1.4 [IQR: 0.9-2.9] versus 0.3 [IQR: 0.1-0.6] mm2/puncture, P < 0.001). Based on the International Consensus Diagnostic Criteria, lymphoplasmacytic infiltration, abundant IgG4-postive cells, storiform fibrosis, and obliterative phlebitis were found in 86%/29%, 64%/0%, 36%/0%, and 7%/0% patients who were treated with the Menghini-type needle and conventional-type needles, respectively. Consequently, histopathological diagnosis with type 1 AIP (lever 1 or 2) was achieved in 9 patients (64%) treated with the Menghini-type needle and in no patient treated with conventional-type needles (P < 0.001). Two patients who had mild post-procedural pancreatitis improved with conservative treatment, and no bleeding occurred in patients treated with the Menghini-type needle. CONCLUSION: EUS-guided rolling method with the 21-gauge Menghini-type biopsy needle is useful for the histopathological diagnosis of AIP, due to its abundant acquisition of good-quality tissue from the pancreas.
Entities:
Keywords:
EUS-FNB; Good-quality tissue; ICDC; Sample area
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