Forward-viewing versus oblique-viewing echoendoscopes in the diagnosis of upper GI subepithelial lesions with EUS-guided FNA: a prospective, randomized, crossover study
Forward-viewing versus oblique-viewing echoendoscopes in the diagnosis of upper GI subepithelial lesions with EUS-guided FNA: a prospective, randomized, crossover study
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DOI：
10.1016/j.gie.2014.12.051
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发表时间：
2015-08-01
影响因子：
7.7
通讯作者：
Goto, Hidemi
中科院分区：
文献类型：
--
作者：
Matsuzaki, Ippei;Miyahara, Ryoji;Goto, Hidemi
背景资料：上消化道subepithelial lesions.Design：前瞻性、随机、交叉研究：三级护理医疗中心：三级护理中心：三级护理中心：患者：41例上消化道上皮下病变的患者。干预措施：所有患者首先接受EUS-FNA与19号针通过使用两个超声内镜，基于随机选择。当需要时，22号或25号针additionally used.Main Outcome Measurements：Comparison of diagnosis yield，tissue sampling area，puncture successfully rates，procedure time，and adverse events.Results：41例患者（中位病变大小22 mm，范围15-63 mm）入选。前视和后视超声内镜的组织学诊断率分别为80.5%（33/41）和73.2%（30/41）（P = 0.453）。前视超声内镜获得的胃肠道间质瘤（n = 22）组织样本面积中位数大于后视超声内镜（2.46 mm（2）vs 1.00 mm 2; P = 0.046）。前视和后视超声内镜的穿刺成功率分别为39/41（95.1%）和35/41（85.4%; P = 0.289）。前视超声内镜的中位手术时间为21分钟，后视超声内镜的中位手术时间为27分钟（P = .009）。一例患者发生感染性不良事件，并接受抗生素治疗。局限性：样本量小。结论：2种超声内镜的诊断率没有差异。然而，前视超声内镜的组织样本面积和手术时间上级。
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 mm(2) 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.