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Mo1295 Safety and Utility of Endoscopic Ultrasound-Guided Fine Needle Aspiration in Focal Lesions of the Spleen
Abstracts
respectively ( P<0.001); only two patient in the latter survived more than 2 years. Conclusions: Using our definition of esophageal stricture by endoscopy and miniprobe EUS can predict the prognosis of advanced esophageal SCC, and select suitable case for surgical resection with better outcome.
Mo1295 Safety and Utility of Endoscopic Ultrasound-Guided Fine Needle Aspiration in Focal Lesions of the Spleen Surinder S. Rana*, Vishal Sharma, Ravi Sharma, Rajesh Gupta Postgraduate Institute of Medical Education & Research, Chandigarh, India Introduction: Fine needle aspiration (FNA) of the splenic lesions is usually done under ultrasound (US) or CT (guidance). However, if the lesion is small or adjacent to the splenic hilum, US or CT guided FNA may be difficult. Endoscopic ultrasound (EUS), because of its ability to provide high resolution images, may be helpful in these situations. Objective: To retrospectively, study the safety and efficacy of EUS guided FNA to elucidate the tissue diagnosis of splenic lesions. Methods: A retrospective analysis of the patients with focal splenic lesions undergoing EUS guided FNA/aspiration over last six years was done. These lesions were either located near the hilum or were small & difficult to sample under US guidance or were not visualised on transabdominal US or the initial US guided FNA was inconclusive. Results: EUS-FNA was performed in 16 patients (age range: 28-43 years; male: 11). Of these 16, US guided FNA was inconclusive in 2 patients, lesions were too small for US FNA in 6, close to hilum in 6 or not visualised on US in 2 patients. 22-gauge needles were used in 13 patients, 25 gauge needle in 2 patients and 19 gauge needle in 1 patient. All the patients had abdominal pain on presentation with 6 patients also complaining of fever. EUS could successfully visualise and evaluate spleen in all patients. Nine patients had focal hypoechoic lesion/lesions of spleen whereas 7 patients had focal cystic lesion. The size of the focal lesions ranged from 0.8 to 1.5 cm whereas for the cystic lesions it ranged from 0.6 cm to 10cms. EUS guided aspiration could be successfully done in all 16 patients (Fig 1). The cytology was adequate in all patients and the diagnosis could be established 13 (81%) patients. The final diagnoses in patients with focal lesions were tuberculosis in six patients and sarcoidosis in two patients. The final diagnosis in patients with cystic lesions were pseudocyst in 5 patients and simple cyst in 3 patients respectively. EUS elastography was done in three patients with hypoechoic lesions and it revealed the lesion to be hard in 2 patients (one each sarcoid and tuberculosis) (Fig 1) and soft in one patient (tuberculosis). One patient with splenic pseudocyst had massive gastrointestinal haemorrhage 7 days after EUS guided aspiration and underwent successful surgery for splenic artery pseudoaneurysm. No other major complications were encountered in any patient. Conclusion: EUS guided FNA of focal splenic lesions is safe and provides adequate material for cytological examination even for small lesions.
Mo1296 Endoscopic Ultrasound Guided Fine Needle Core Liver Biopsy Using a Novel 19 Gauge Needle With Modified One Pass Wet Suction Technique Jose Nieto*1,2, Huda Khaleel4, Youssef P. Challita4, Melissa Jimenez4, Todd H. Baron5, Kelli Hathaway1, Laura R. Walter1, Ketul Patel1,2, Ali Lankarani1,2, Michael Herman1, David Holloman2, Sammy Saab3,4 1 Gastroenterology, Borland Groover Clinic, Jacksonville, FL; 2 Gastroenterology, Baptist Medical Center, Jacksonville, FL; 3Medicine, University of California, Los Angeles, Los Angeles, CA; 4Surgery, University of California, Los Angeles, Los Angeles, CA; 5Gastroenterology, University of North Carolina, Chapel Hill, Chapel Hill, NC Background: Endoscopic ultrasound (EUS)-guided fine needle core biopsy has been demonstrated to be a safe and effective technique. However, data are limited in its role in parenchymal disease. We evaluated the utility of EUS-guided parenchymal liver biopsies (EUS-LB) with a Modified One Pass Wet Suction Technique (EUS-MLB) in patients with unexplained increase in liver associated tests. Methods: We retrospectively evaluated the safety and efficacy of EUS-MLB in patients referred for EUS to evaluate for biliary obstruction and pancreatic disorders, but with associated unexplained liver tests. EUS-MLB was performed during the same session after biliary obstruction was excluded. Results: One hundred and sixty-five consecutive patients underwent EUS-MLB. The median (interquartile range [IQR]) age was 52 years (42, 65). Sixty-eight patients (41%) were male. The median (IQR) of the maximum intact core tissue length was 2.4 cm (1.8, 3.5). The median (IQR) total specimen length (TSL) was 6 cm (4.3, 8). The median (IQR) number of complete portal tracts (CPT) per TSL was 18 (13, 24). The mean number of CPT per sample length was 7.5/cm. Adverse events were uncommon (1.8%), and included abdominal pain and self-limited hematoma. Discussion: Endoscopic ultrasound-guided fine needle biopsy using a novel 19 Gauge core needle with a Modified One Pass Wet Suction Technique (EUS-MLB) is a safe and effective way to assess unexplained associated liver tests abnormalities in patients undergoing EUS for and exclusion of biliary obstruction.
Patient Demographics Parameters Number of patients (N) Age, Median, (IQR), years Gender. n (%) Male Female Body Mass Index, Median, (IQR) Alcohol Use, n (%) Indication for liver biopsy, n (%) Abnormal Liver Tests Abnormal Echogenicity on EUS Viral Hepatitis Intact maximum specimen length, Median (IQR), cm Total Specimen Length, Mediation (IQR), cm Number of CPTs, Median (IQR) Risk of Complication, n (%)
Results 165 52 (42, 65) 68 97 28 35
(41.2%) (58.7%) (24, 32) (21.2%)
148 (89.7%) 147 (89.1%) 37 (22.4%) 2.4 (1.8, 3.5) 6 (4.3, 8) 18 (13,24) 3 (1.8%)
Abbreviations: IQR w Interquartile Range; EUS w Endoscopic Ultrasound; CPT w Complete Portal Tracts; n w number
Fig Fig Fig Fig
1A: CT: Small focal lesion in spleen with minimal ascites. 1B: EUS: Focal Hypoechoic lesions in spleen. 1C: EUS elastography showing lesions to be hard. 1D: EUS guided FNA of splenic lesion.
AB494 GASTROINTESTINAL ENDOSCOPY Volume 85, No. 5S : 2017
www.giejournal.org
respectively ( P<0.001); only two patient in the latter survived more than 2 years. Conclusions: Using our definition of esophageal stricture by endoscopy and miniprobe EUS can predict the prognosis of advanced esophageal SCC, and select suitable case for surgical resection with better outcome.
Mo1295 Safety and Utility of Endoscopic Ultrasound-Guided Fine Needle Aspiration in Focal Lesions of the Spleen Surinder S. Rana*, Vishal Sharma, Ravi Sharma, Rajesh Gupta Postgraduate Institute of Medical Education & Research, Chandigarh, India Introduction: Fine needle aspiration (FNA) of the splenic lesions is usually done under ultrasound (US) or CT (guidance). However, if the lesion is small or adjacent to the splenic hilum, US or CT guided FNA may be difficult. Endoscopic ultrasound (EUS), because of its ability to provide high resolution images, may be helpful in these situations. Objective: To retrospectively, study the safety and efficacy of EUS guided FNA to elucidate the tissue diagnosis of splenic lesions. Methods: A retrospective analysis of the patients with focal splenic lesions undergoing EUS guided FNA/aspiration over last six years was done. These lesions were either located near the hilum or were small & difficult to sample under US guidance or were not visualised on transabdominal US or the initial US guided FNA was inconclusive. Results: EUS-FNA was performed in 16 patients (age range: 28-43 years; male: 11). Of these 16, US guided FNA was inconclusive in 2 patients, lesions were too small for US FNA in 6, close to hilum in 6 or not visualised on US in 2 patients. 22-gauge needles were used in 13 patients, 25 gauge needle in 2 patients and 19 gauge needle in 1 patient. All the patients had abdominal pain on presentation with 6 patients also complaining of fever. EUS could successfully visualise and evaluate spleen in all patients. Nine patients had focal hypoechoic lesion/lesions of spleen whereas 7 patients had focal cystic lesion. The size of the focal lesions ranged from 0.8 to 1.5 cm whereas for the cystic lesions it ranged from 0.6 cm to 10cms. EUS guided aspiration could be successfully done in all 16 patients (Fig 1). The cytology was adequate in all patients and the diagnosis could be established 13 (81%) patients. The final diagnoses in patients with focal lesions were tuberculosis in six patients and sarcoidosis in two patients. The final diagnosis in patients with cystic lesions were pseudocyst in 5 patients and simple cyst in 3 patients respectively. EUS elastography was done in three patients with hypoechoic lesions and it revealed the lesion to be hard in 2 patients (one each sarcoid and tuberculosis) (Fig 1) and soft in one patient (tuberculosis). One patient with splenic pseudocyst had massive gastrointestinal haemorrhage 7 days after EUS guided aspiration and underwent successful surgery for splenic artery pseudoaneurysm. No other major complications were encountered in any patient. Conclusion: EUS guided FNA of focal splenic lesions is safe and provides adequate material for cytological examination even for small lesions.
Mo1296 Endoscopic Ultrasound Guided Fine Needle Core Liver Biopsy Using a Novel 19 Gauge Needle With Modified One Pass Wet Suction Technique Jose Nieto*1,2, Huda Khaleel4, Youssef P. Challita4, Melissa Jimenez4, Todd H. Baron5, Kelli Hathaway1, Laura R. Walter1, Ketul Patel1,2, Ali Lankarani1,2, Michael Herman1, David Holloman2, Sammy Saab3,4 1 Gastroenterology, Borland Groover Clinic, Jacksonville, FL; 2 Gastroenterology, Baptist Medical Center, Jacksonville, FL; 3Medicine, University of California, Los Angeles, Los Angeles, CA; 4Surgery, University of California, Los Angeles, Los Angeles, CA; 5Gastroenterology, University of North Carolina, Chapel Hill, Chapel Hill, NC Background: Endoscopic ultrasound (EUS)-guided fine needle core biopsy has been demonstrated to be a safe and effective technique. However, data are limited in its role in parenchymal disease. We evaluated the utility of EUS-guided parenchymal liver biopsies (EUS-LB) with a Modified One Pass Wet Suction Technique (EUS-MLB) in patients with unexplained increase in liver associated tests. Methods: We retrospectively evaluated the safety and efficacy of EUS-MLB in patients referred for EUS to evaluate for biliary obstruction and pancreatic disorders, but with associated unexplained liver tests. EUS-MLB was performed during the same session after biliary obstruction was excluded. Results: One hundred and sixty-five consecutive patients underwent EUS-MLB. The median (interquartile range [IQR]) age was 52 years (42, 65). Sixty-eight patients (41%) were male. The median (IQR) of the maximum intact core tissue length was 2.4 cm (1.8, 3.5). The median (IQR) total specimen length (TSL) was 6 cm (4.3, 8). The median (IQR) number of complete portal tracts (CPT) per TSL was 18 (13, 24). The mean number of CPT per sample length was 7.5/cm. Adverse events were uncommon (1.8%), and included abdominal pain and self-limited hematoma. Discussion: Endoscopic ultrasound-guided fine needle biopsy using a novel 19 Gauge core needle with a Modified One Pass Wet Suction Technique (EUS-MLB) is a safe and effective way to assess unexplained associated liver tests abnormalities in patients undergoing EUS for and exclusion of biliary obstruction.
Patient Demographics Parameters Number of patients (N) Age, Median, (IQR), years Gender. n (%) Male Female Body Mass Index, Median, (IQR) Alcohol Use, n (%) Indication for liver biopsy, n (%) Abnormal Liver Tests Abnormal Echogenicity on EUS Viral Hepatitis Intact maximum specimen length, Median (IQR), cm Total Specimen Length, Mediation (IQR), cm Number of CPTs, Median (IQR) Risk of Complication, n (%)
Results 165 52 (42, 65) 68 97 28 35
(41.2%) (58.7%) (24, 32) (21.2%)
148 (89.7%) 147 (89.1%) 37 (22.4%) 2.4 (1.8, 3.5) 6 (4.3, 8) 18 (13,24) 3 (1.8%)
Abbreviations: IQR w Interquartile Range; EUS w Endoscopic Ultrasound; CPT w Complete Portal Tracts; n w number
Fig Fig Fig Fig
1A: CT: Small focal lesion in spleen with minimal ascites. 1B: EUS: Focal Hypoechoic lesions in spleen. 1C: EUS elastography showing lesions to be hard. 1D: EUS guided FNA of splenic lesion.
AB494 GASTROINTESTINAL ENDOSCOPY Volume 85, No. 5S : 2017
www.giejournal.org