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P.06.16: The Role of Wireless Capsule Endoscopy in the Diagnosis of Small Bowel Tumors: A Single Centre Experience
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Abstracts of the 23rd National Congress of Digestive Diseases / Digestive and Liver Disease 49S2 (2017) e73–e223
yield of the 19-gauge Flex needle for endoscopic ultrasound fine needle aspiration and biopsy of pancreatic cystic lesions. Material and methods: 54 patients with pancreatic cystic lesions were consecutively referred for endoscopic ultrasound guided-fine needle aspiration. They were enrolled in a prospective, single center study and underwent fine needle aspiration and biopsy with the 19-gauge Flex needle. Results: In 54 patients (M 25, median age 69 years), pancreatic cystic lesions were rapidly reached. Technical success indeed was 100%, with 27 transbulbar and 27 transgastric route and safety achieved was 100%, as well. Considering the different sites, 27 (50%) lesions were in the pancreatic head/uncinate, 23 (42.6%) in the body and 4 (7.40%) in the tail. Median dimensions were 36 mm. Malignancy was detected with adequate samples in 11 cases including 6 adenocarcinoma and 5 high grade dysplasia and 2 cases standed out as cytological sampling failure. Definitive diagnosis included 7 serous lesions, 31 IPMN type I and type II with 3 cases of degeneration, 5 pseudocysts, 9 mucinous cystic neoplasms and 2 neuroendocrine tumours. Further evaluation on the cystic content was performed by dosing oncomarkers, with high level of CA 19.9 in 11 and CEA in 38 cases, respectively and increased amylase and lipase both in 34 lesions. K-ras gene was even detected in 28 lesions, with wild type expression in 17 ones. There was only 1 minor complication represented by 1 case of mild infection. Conclusions: Fine needle aspiration and biopsy with the 19-gauge Flex needle is feasible, particularly in pancreatic cystic lesions with solid component or malignancy, with a high diagnostic yield and with no increase in complication rate. Furthermore, the use of 19- gauge Flex needle for aspiration in pancreatic cystic lesions will allow the use of new devices, like microforceps and optical biopsy, improving the future management of these lesions.
Our aim was to show the diagnostic performance of the Institution of a unit combining the opportunity of performing both EUS and EBUS-FNA for hilar-mediastinal district. Material and methods: In September 2015, a combined unit, composed by a digestive and a thoracic endoscopist, have been constituted in our department. This allowed us to choose the best diagnostic approach (EUS and/or EBUS-FNA) according to the lymph node stations involved. When both EUS and EBUS were technically faceable, the endoscopic approach has been chosen due to the lower risk of side effects. A surgical diagnostic lymphadenectomy or an oncological follow up have been performed in all FNA-negative patients. Clinical and histological data of patients undergone to EUS/EBUSFNA in a period of 6-months were collected and analyzed. Results: During the period of analysis (September 2015–February 2016), 91 EUS/EBUS FNA (50 EUS-FNA, 37 EBUS-FNA, 2 EUS/EBUSFNA and 2 EUS-B-FNA) of hilar-mediastinal and/or para-mediastinal mass were performed in 85 patients. Among them, 54 histological diagnosis of non-small cell lung cancer, 5 of small cell lung cancer, 9 of lymph node metastasis from other tumors, 2 of sarcoidosis and 2 of hamartoma were obtained. No complications related to the procedures occurred. In 5 of the 9 patients FNA-negative at this endoscopic approach a surgical staging lymphadenectomy was performed and the presence of lymph node disease has been documented in 4 patients. In the 10 FNA-negative patients undergone to follow up, no further suspicion of neoplasia raised. The combined approach resulted accurate (95%) and sensitive (95%). Conclusions: The institution of an endoscopic ultrasound unit with the opportunity of a combined endoscopic and/or endobronchial ultrasonographic approach for the mini-invasive hilar-mediastinal diagnosis improves the diagnostic performance in this setting and, thanks to that, the spectrum of patients which may avoid the surgical approach is broader.
P.06.16 P.06.14 Abstract withdrawn
THE ROLE OF WIRELESS CAPSULE ENDOSCOPY IN THE DIAGNOSIS OF SMALL BOWEL TUMORS: A SINGLE CENTRE EXPERIENCE
P.06.15
G. Scarpulla, S. Camilleri, G.M.G. La Ferrera, M. Manganaro, M.F. Maida, S.M.R. Garufi ∗
THE INSTITUTION OF AN ENDOSCOPIC ULTRASOUND UNIT WITH THE OPPORTUNITY OF A COMBINED ENDOSCOPIC AND ENDOBRONCHIAL ULTRASONOGRAPHIC APPROACH FOR THE MINI-INVASIVE HILAR MEDIASTINAL DIAGNOSIS IMPROVES THE DIAGNOSTIC PERFORMANCE IN THIS SETTING D. Assisi ∗,1 , C. Lucidi 1 , D. Forcella 2 , F. Pieconti 4 , P. Visca 3 , F. Facciolo 2 , M. Anti 1 1 Unità
Operativa di Gastroenterologia ed Endoscopia Digestiva, Polo Oncologico Istituto Regina Elena, Roma, Rome, Italy; 2 Unità Operativa Complessa di Chirurgia Toracica, Polo Oncologico Istituto Regina Elena, Roma, Rome, Italy; 3 Unità Operativa Complessa di Anatomia Patologica, Polo Oncologico Istituto Regina Elena, Roma, Rome, Italy; 4 Unità Operativa Complessa di Anestesia e Rianimazione, Polo Oncologico Istituto Regina Elena, Roma, Rome, Italy Background and aim: The efficacy of endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) as minimally invasive technique in the differential diagnosis of hilar-mediastinal lymphadenopathies is now widely recognized. The use of EUS has allowed to easily reach some of the hilarmediastinal lymph nodes stations without obtaining a complete study. This evaluation may be integrated by endobronchial ultrasound (EBUS) with FNA.
U.O.C. Gastroenterologia, P.O. “M. Raimondi”, San Cataldo (Cl), Italy Background and aim: Most small bowel (SB) tumors are detected during work-up for obscure gastrointestinal bleeding (OGIB) and they represent less than 6% of digestive tumors. The clinical manifestations of SB tumor tend to be nonspecific and this can delay the diagnosis, especially in the early stage. Wireless capsule endoscopy (WCE) is preferred by both patients and physicians mainly because of its non-invasiveness and is widely used as the first-line diagnostic modality for OGIB. Its use is recommended when traditional esophagogastroduodenoscopy and colonoscopy with ileoscopy resulted negative for disease. The aim of this study is to assess the clinical applicability and diagnostic yeld of WCE in neoplasm’s diagnosis in a large group of patients with OGIB in a single Italian centre. Material and methods: Between June 2003 and September 2016, 568 patients (pts) (324 males, 244 females; mean age 68.5 years; range 20–92 years) underwent WCE for OGIB (358 for OGIB occult and 210 for OGIB overt). A very careful selection of the pts has been carried: all subjects had a previous complete diagnostic work-up. The day before the WCE the patients followed a liquid and no fiber diet; the videocapsule was swallowed after an overnight fasting. In 13 cases, WCE were not diagnostic: 5 due prolonged permanence of the videocapsules in the stomach and 8 due to insufficient bowel cleaning. In 89% of patients we obtained a visualization of the entire
Abstracts of the 23rd National Congress of Digestive Diseases / Digestive and Liver Disease 49S2 (2017) e73–e223
SB with an average 230 minutes of intestinal transit time with the finding of an optimal intestinal toilette in 71% of patients. Results: WCE identified 17 SB tumors (diagnostic yeld 3%), of with 13 malignancied (76%) and 4 benign neoplasms (24%). Malignancies included 8 pts with adenocarcinoma (61%), 4 pts with gastrointestinal stromal tumors (GIST) (31%) and 1 metastatic lesion of malignant melanoma (7%). Benign neoplasms included 4 pts with dysplastic adenomatous polyps (100%). No adverse events occurred and all pts have evacuated the WCE within 1–10 days from the execution of the examination. Conclusions: In our experience, WCE is a clinically useful technique and sensitive diagnostic tool for the diagnosis of SB tumors undetected by conventional endoscopic testing. The non-invasive technique, the excellent tolerability and the good diagnostic return are its points of strength.
P.06.17 EUS-GUIDED SAMPLING: A SINGLE CENTER PRELIMINARY COMPARATIVE EXPERIENCE OF STANDARD FNA AND A NEW FNB NEEDLE E. Dabizzi ∗ , M.C. Petrone, A. Mariani, S.G.G. Testoni, G. Rossi, M. Traini, P. Magnoni, P.G. Arcidiacono Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy Background and aim: EUS-guided FNA is the current standard method for tissue diagnosis of abdominal masses, with low risk rate and high sensitivity and sensibility. However, several factors can affect its accuracy. Different methods have been proposed to improve quality, such as recently, a new core needle, to obtain both cytological and histological samples. Aim: To assess the quality of EUS-guided samples, comparing two different needles, in order to optimize tissue acquisition. Material and methods: Patients with pancreatic lesions, pathological lymph nodes or submucosal undetermined mass, requiring EUS-FNA, at our tertiary referral Center, were prospectively enrolled in the study between March 2015 and September 2016. All procedures were done under deep sedation. FNA was performed using both a standard 25G and a new 20G core needle (EchoTip Ultra/ProCore, Cook Medical), with capillary technique. Patients were randomized to undergo firstly one or the other needle. Feasibility, technical success, number of passes, accuracy and complications of the two needles were assessed. Samples were evaluated on site by expert cytotechnologist, after quick hematoxylin-eosin standardized staining. An expert cyto-pathologist, blinded for the needle used, reviewed the slides, for final diagnosis and sample quality, through the evaluation of the target cells amount, the presence of tissue cores and the concordance with final diagnosis. Data were analyzed with Student’s t-test and chi squared test, assuming a significant p-value of 0.05. Results: 24 patients (12 M, mean age 66.12 yo), with pancreatic masses (12/24, 50%), pathological lymph nodes (5/24, 21%) and undetermined masses (7/24, 29%) were included in the study. The lesions mean size was 36.4 mm. Tissue sampling was feasible in both groups, with a 100% technical success rate. 20G needle insertion was comparable to the standard 25G, despite the needle size and the lesion site. A significant lower number of passes was reported with the 25G (1.375 vs. 2.625, p<0.05) to reach qualitative adequacy. Tissue core amount was significantly higher in 20G vs. 25G samples (75% vs. 37.5%). Adequacy rate for final diagnosis was 92% (22/24) with 25G and 75% (18/24) with 20G needle (p=0.12). No complications were reported. Conclusions: The new 20G needle is technically feasible, safe and
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qualitative comparable with the standard 25G needle, providing more tissue cores. However, the requirement of different sample preparation and staining for cytology and histology specimens can affect the opportunity of on-site evaluation and consequently the number of passes.
P.06.18 ROLE OF SHARKSCORE NEEDLE BIOPSY IN EUS-ENDOSCOPY: IS A SINGLE PASS ENOUGH? I. Bortoluzzi ∗,1 , G. Lollo 1 , C. Mescoli 2 , M. Rugge 2 , G.C. Sturniolo 1 , A. Fantin 1 1 Section
of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, Padova, Italy; 2 Surgical Pathology & Cytopathology Unit, Department of Medicine, University Hospital Padua, Padova, Italy Background and aim: Although EUS-guided fine needle aspiration (EUS–FNA) is a well-established method to obtain cells for cytological evaluation, there are not univocal consent about the number of passes necessary to obtain an adequate tissue sampling during fine needle biopsy (FNB). The aim is to evaluate adequacy of material obtained by needle biopsy performed with SharkCore needle. Material and methods: We considered patients referred for EUSguided tissue sampling in our Institution from January 2016 to October 2016; linear-array Eus-endoscopy Olympus (UCT140) with a 22–25 gauge FNB (Sharkcore-Covidien) was used by a single operator. One to seven passes (median 4) were performed to obtain tissue cores. The collected samples were separated in two different bottles with formalin. Bottle 1: tissue from the first pass; bottle 2: tissue obtained from the following passes. Results: 58 patients were examined (35 male, 23 female) with a mean age of 64.8 years old; in all patients biopsy sampling has been successful. The distribution of the target lesion was as follow: 11 solid mediastinal lesions, 36 pancreatic solid lesions, 4 duodenal submucosal lesions, 10 gastric mucosal and submucosal mass and 4 other abdominal lesions. The overall adequacy was 96.3%. In Bottle 1 adequacy was 93% (4 inadequate samples for uncellularity) and of 96.5% in bottle 2 (2 inadequate samples for uncellularity). Histology analysis showed: 1 neuroendocrine tumor, 3 metastasis (2 lung adenocarcinoma and 1 kidney carcinoma) between mediastinal lesions, 15 pancreatic adenocarcinoma, 2 neuroendocrin tumors between the pancreatic lesion, 3 leiomyoma, 3 GIST, 2 gastric adenocarcinomas between duodenal and gastric lesions and 1 neuroendocrine tumor between others intra-abdominal lesions. The remaining samples were negative for malignancy with subsequent 6-month clinical follow-up. Conclusions: These preliminary data, even in a small group of patients with heterogeneous lesions, show high adequacy of sampling carried out by SharkCore needle biopsy during Eus-Endoscopy even after a single pass.
P.06.19 DIAGNOSTIC ACCURACY OF ENDOSCOPIC ULTRASOUND ELASTOGRAPHY TARGETED FINE NEEDLE ASPIRATION FOR SOLID PANCREATIC LESIONS A. Facciorusso ∗ , M. Di Maso, G. Serviddio, V. Del Prete, N. Muscatiello Università di Foggia, Foggia, Italy Background and aim: Diagnostic assessment of solid pancreatic lesions may represent a real challenge in the clinical practice, even with the aid of tissue sampling by means of endoscopic
Abstracts of the 23rd National Congress of Digestive Diseases / Digestive and Liver Disease 49S2 (2017) e73–e223
yield of the 19-gauge Flex needle for endoscopic ultrasound fine needle aspiration and biopsy of pancreatic cystic lesions. Material and methods: 54 patients with pancreatic cystic lesions were consecutively referred for endoscopic ultrasound guided-fine needle aspiration. They were enrolled in a prospective, single center study and underwent fine needle aspiration and biopsy with the 19-gauge Flex needle. Results: In 54 patients (M 25, median age 69 years), pancreatic cystic lesions were rapidly reached. Technical success indeed was 100%, with 27 transbulbar and 27 transgastric route and safety achieved was 100%, as well. Considering the different sites, 27 (50%) lesions were in the pancreatic head/uncinate, 23 (42.6%) in the body and 4 (7.40%) in the tail. Median dimensions were 36 mm. Malignancy was detected with adequate samples in 11 cases including 6 adenocarcinoma and 5 high grade dysplasia and 2 cases standed out as cytological sampling failure. Definitive diagnosis included 7 serous lesions, 31 IPMN type I and type II with 3 cases of degeneration, 5 pseudocysts, 9 mucinous cystic neoplasms and 2 neuroendocrine tumours. Further evaluation on the cystic content was performed by dosing oncomarkers, with high level of CA 19.9 in 11 and CEA in 38 cases, respectively and increased amylase and lipase both in 34 lesions. K-ras gene was even detected in 28 lesions, with wild type expression in 17 ones. There was only 1 minor complication represented by 1 case of mild infection. Conclusions: Fine needle aspiration and biopsy with the 19-gauge Flex needle is feasible, particularly in pancreatic cystic lesions with solid component or malignancy, with a high diagnostic yield and with no increase in complication rate. Furthermore, the use of 19- gauge Flex needle for aspiration in pancreatic cystic lesions will allow the use of new devices, like microforceps and optical biopsy, improving the future management of these lesions.
Our aim was to show the diagnostic performance of the Institution of a unit combining the opportunity of performing both EUS and EBUS-FNA for hilar-mediastinal district. Material and methods: In September 2015, a combined unit, composed by a digestive and a thoracic endoscopist, have been constituted in our department. This allowed us to choose the best diagnostic approach (EUS and/or EBUS-FNA) according to the lymph node stations involved. When both EUS and EBUS were technically faceable, the endoscopic approach has been chosen due to the lower risk of side effects. A surgical diagnostic lymphadenectomy or an oncological follow up have been performed in all FNA-negative patients. Clinical and histological data of patients undergone to EUS/EBUSFNA in a period of 6-months were collected and analyzed. Results: During the period of analysis (September 2015–February 2016), 91 EUS/EBUS FNA (50 EUS-FNA, 37 EBUS-FNA, 2 EUS/EBUSFNA and 2 EUS-B-FNA) of hilar-mediastinal and/or para-mediastinal mass were performed in 85 patients. Among them, 54 histological diagnosis of non-small cell lung cancer, 5 of small cell lung cancer, 9 of lymph node metastasis from other tumors, 2 of sarcoidosis and 2 of hamartoma were obtained. No complications related to the procedures occurred. In 5 of the 9 patients FNA-negative at this endoscopic approach a surgical staging lymphadenectomy was performed and the presence of lymph node disease has been documented in 4 patients. In the 10 FNA-negative patients undergone to follow up, no further suspicion of neoplasia raised. The combined approach resulted accurate (95%) and sensitive (95%). Conclusions: The institution of an endoscopic ultrasound unit with the opportunity of a combined endoscopic and/or endobronchial ultrasonographic approach for the mini-invasive hilar-mediastinal diagnosis improves the diagnostic performance in this setting and, thanks to that, the spectrum of patients which may avoid the surgical approach is broader.
P.06.16 P.06.14 Abstract withdrawn
THE ROLE OF WIRELESS CAPSULE ENDOSCOPY IN THE DIAGNOSIS OF SMALL BOWEL TUMORS: A SINGLE CENTRE EXPERIENCE
P.06.15
G. Scarpulla, S. Camilleri, G.M.G. La Ferrera, M. Manganaro, M.F. Maida, S.M.R. Garufi ∗
THE INSTITUTION OF AN ENDOSCOPIC ULTRASOUND UNIT WITH THE OPPORTUNITY OF A COMBINED ENDOSCOPIC AND ENDOBRONCHIAL ULTRASONOGRAPHIC APPROACH FOR THE MINI-INVASIVE HILAR MEDIASTINAL DIAGNOSIS IMPROVES THE DIAGNOSTIC PERFORMANCE IN THIS SETTING D. Assisi ∗,1 , C. Lucidi 1 , D. Forcella 2 , F. Pieconti 4 , P. Visca 3 , F. Facciolo 2 , M. Anti 1 1 Unità
Operativa di Gastroenterologia ed Endoscopia Digestiva, Polo Oncologico Istituto Regina Elena, Roma, Rome, Italy; 2 Unità Operativa Complessa di Chirurgia Toracica, Polo Oncologico Istituto Regina Elena, Roma, Rome, Italy; 3 Unità Operativa Complessa di Anatomia Patologica, Polo Oncologico Istituto Regina Elena, Roma, Rome, Italy; 4 Unità Operativa Complessa di Anestesia e Rianimazione, Polo Oncologico Istituto Regina Elena, Roma, Rome, Italy Background and aim: The efficacy of endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) as minimally invasive technique in the differential diagnosis of hilar-mediastinal lymphadenopathies is now widely recognized. The use of EUS has allowed to easily reach some of the hilarmediastinal lymph nodes stations without obtaining a complete study. This evaluation may be integrated by endobronchial ultrasound (EBUS) with FNA.
U.O.C. Gastroenterologia, P.O. “M. Raimondi”, San Cataldo (Cl), Italy Background and aim: Most small bowel (SB) tumors are detected during work-up for obscure gastrointestinal bleeding (OGIB) and they represent less than 6% of digestive tumors. The clinical manifestations of SB tumor tend to be nonspecific and this can delay the diagnosis, especially in the early stage. Wireless capsule endoscopy (WCE) is preferred by both patients and physicians mainly because of its non-invasiveness and is widely used as the first-line diagnostic modality for OGIB. Its use is recommended when traditional esophagogastroduodenoscopy and colonoscopy with ileoscopy resulted negative for disease. The aim of this study is to assess the clinical applicability and diagnostic yeld of WCE in neoplasm’s diagnosis in a large group of patients with OGIB in a single Italian centre. Material and methods: Between June 2003 and September 2016, 568 patients (pts) (324 males, 244 females; mean age 68.5 years; range 20–92 years) underwent WCE for OGIB (358 for OGIB occult and 210 for OGIB overt). A very careful selection of the pts has been carried: all subjects had a previous complete diagnostic work-up. The day before the WCE the patients followed a liquid and no fiber diet; the videocapsule was swallowed after an overnight fasting. In 13 cases, WCE were not diagnostic: 5 due prolonged permanence of the videocapsules in the stomach and 8 due to insufficient bowel cleaning. In 89% of patients we obtained a visualization of the entire
Abstracts of the 23rd National Congress of Digestive Diseases / Digestive and Liver Disease 49S2 (2017) e73–e223
SB with an average 230 minutes of intestinal transit time with the finding of an optimal intestinal toilette in 71% of patients. Results: WCE identified 17 SB tumors (diagnostic yeld 3%), of with 13 malignancied (76%) and 4 benign neoplasms (24%). Malignancies included 8 pts with adenocarcinoma (61%), 4 pts with gastrointestinal stromal tumors (GIST) (31%) and 1 metastatic lesion of malignant melanoma (7%). Benign neoplasms included 4 pts with dysplastic adenomatous polyps (100%). No adverse events occurred and all pts have evacuated the WCE within 1–10 days from the execution of the examination. Conclusions: In our experience, WCE is a clinically useful technique and sensitive diagnostic tool for the diagnosis of SB tumors undetected by conventional endoscopic testing. The non-invasive technique, the excellent tolerability and the good diagnostic return are its points of strength.
P.06.17 EUS-GUIDED SAMPLING: A SINGLE CENTER PRELIMINARY COMPARATIVE EXPERIENCE OF STANDARD FNA AND A NEW FNB NEEDLE E. Dabizzi ∗ , M.C. Petrone, A. Mariani, S.G.G. Testoni, G. Rossi, M. Traini, P. Magnoni, P.G. Arcidiacono Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy Background and aim: EUS-guided FNA is the current standard method for tissue diagnosis of abdominal masses, with low risk rate and high sensitivity and sensibility. However, several factors can affect its accuracy. Different methods have been proposed to improve quality, such as recently, a new core needle, to obtain both cytological and histological samples. Aim: To assess the quality of EUS-guided samples, comparing two different needles, in order to optimize tissue acquisition. Material and methods: Patients with pancreatic lesions, pathological lymph nodes or submucosal undetermined mass, requiring EUS-FNA, at our tertiary referral Center, were prospectively enrolled in the study between March 2015 and September 2016. All procedures were done under deep sedation. FNA was performed using both a standard 25G and a new 20G core needle (EchoTip Ultra/ProCore, Cook Medical), with capillary technique. Patients were randomized to undergo firstly one or the other needle. Feasibility, technical success, number of passes, accuracy and complications of the two needles were assessed. Samples were evaluated on site by expert cytotechnologist, after quick hematoxylin-eosin standardized staining. An expert cyto-pathologist, blinded for the needle used, reviewed the slides, for final diagnosis and sample quality, through the evaluation of the target cells amount, the presence of tissue cores and the concordance with final diagnosis. Data were analyzed with Student’s t-test and chi squared test, assuming a significant p-value of 0.05. Results: 24 patients (12 M, mean age 66.12 yo), with pancreatic masses (12/24, 50%), pathological lymph nodes (5/24, 21%) and undetermined masses (7/24, 29%) were included in the study. The lesions mean size was 36.4 mm. Tissue sampling was feasible in both groups, with a 100% technical success rate. 20G needle insertion was comparable to the standard 25G, despite the needle size and the lesion site. A significant lower number of passes was reported with the 25G (1.375 vs. 2.625, p<0.05) to reach qualitative adequacy. Tissue core amount was significantly higher in 20G vs. 25G samples (75% vs. 37.5%). Adequacy rate for final diagnosis was 92% (22/24) with 25G and 75% (18/24) with 20G needle (p=0.12). No complications were reported. Conclusions: The new 20G needle is technically feasible, safe and
e171
qualitative comparable with the standard 25G needle, providing more tissue cores. However, the requirement of different sample preparation and staining for cytology and histology specimens can affect the opportunity of on-site evaluation and consequently the number of passes.
P.06.18 ROLE OF SHARKSCORE NEEDLE BIOPSY IN EUS-ENDOSCOPY: IS A SINGLE PASS ENOUGH? I. Bortoluzzi ∗,1 , G. Lollo 1 , C. Mescoli 2 , M. Rugge 2 , G.C. Sturniolo 1 , A. Fantin 1 1 Section
of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, Padova, Italy; 2 Surgical Pathology & Cytopathology Unit, Department of Medicine, University Hospital Padua, Padova, Italy Background and aim: Although EUS-guided fine needle aspiration (EUS–FNA) is a well-established method to obtain cells for cytological evaluation, there are not univocal consent about the number of passes necessary to obtain an adequate tissue sampling during fine needle biopsy (FNB). The aim is to evaluate adequacy of material obtained by needle biopsy performed with SharkCore needle. Material and methods: We considered patients referred for EUSguided tissue sampling in our Institution from January 2016 to October 2016; linear-array Eus-endoscopy Olympus (UCT140) with a 22–25 gauge FNB (Sharkcore-Covidien) was used by a single operator. One to seven passes (median 4) were performed to obtain tissue cores. The collected samples were separated in two different bottles with formalin. Bottle 1: tissue from the first pass; bottle 2: tissue obtained from the following passes. Results: 58 patients were examined (35 male, 23 female) with a mean age of 64.8 years old; in all patients biopsy sampling has been successful. The distribution of the target lesion was as follow: 11 solid mediastinal lesions, 36 pancreatic solid lesions, 4 duodenal submucosal lesions, 10 gastric mucosal and submucosal mass and 4 other abdominal lesions. The overall adequacy was 96.3%. In Bottle 1 adequacy was 93% (4 inadequate samples for uncellularity) and of 96.5% in bottle 2 (2 inadequate samples for uncellularity). Histology analysis showed: 1 neuroendocrine tumor, 3 metastasis (2 lung adenocarcinoma and 1 kidney carcinoma) between mediastinal lesions, 15 pancreatic adenocarcinoma, 2 neuroendocrin tumors between the pancreatic lesion, 3 leiomyoma, 3 GIST, 2 gastric adenocarcinomas between duodenal and gastric lesions and 1 neuroendocrine tumor between others intra-abdominal lesions. The remaining samples were negative for malignancy with subsequent 6-month clinical follow-up. Conclusions: These preliminary data, even in a small group of patients with heterogeneous lesions, show high adequacy of sampling carried out by SharkCore needle biopsy during Eus-Endoscopy even after a single pass.
P.06.19 DIAGNOSTIC ACCURACY OF ENDOSCOPIC ULTRASOUND ELASTOGRAPHY TARGETED FINE NEEDLE ASPIRATION FOR SOLID PANCREATIC LESIONS A. Facciorusso ∗ , M. Di Maso, G. Serviddio, V. Del Prete, N. Muscatiello Università di Foggia, Foggia, Italy Background and aim: Diagnostic assessment of solid pancreatic lesions may represent a real challenge in the clinical practice, even with the aid of tissue sampling by means of endoscopic