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Su1364 High Yield of Core Tissue for Histological Analysis With High Diagnostic Accuracy of Eus-Fine Needle Biopsy Using the 22G Acquire Needle: A Multicenter Prospective Study
Abstracts
Su1363 The Utility of Endoscopic Ultrasound in Patients With Isolated Serum Elevations in Amylase And/Or Lipase: A Single Center Experience Lalitha Sitaraman*1, Amit H. Sachdev2, Tamas Gonda2, Amrita Sethi2, John M. Poneros2, Frank G. Gress2 1 Medicine, Columbia University, New York, NY; 2Digestive and Liver Diseases, Columbia Unversity, New York, NY Background: Isolated elevations in serum levels of pancreatic enzymes (amylase and lipase) may represent pancreatic or non-pancreatic disease. When patients have elevated levels of amylase and/or lipase, they may be symptomatic or asymptomatic, with such elevations incidentally discovered. The diagnostic yield of endoscopic ultrasound (EUS) in these patients is not well described. Methods: A retrospective chart review was conducted at a large tertiary academic medical center from 2000 to 2016. Patients were selected on the basis of having elevated amylase, lipase, or both, but without a diagnosis of acute pancreatitis or known pancreatobiliary disease. Patients were excluded if they had findings suggestive of another etiology, i.e. abnormal serum aminotransferases, bilirubin, or alkaline phosphatase or abnormal imaging of the pancreas. Results from EUS, pathology, and follow up imaging and/or procedures were recorded. Results: Out of 299 EUS performed between 2000-2016 with the indication of elevated amylase and/or lipase, 38 patients met inclusion criteria. Patients were predominantly female (74%), mean age 50.3 (SD 15.6). Symptoms were present in 31 patients, with the most common symptom being abdominal pain (87%). Both amylase and lipase were elevated in 9 patients, with isolated lipase elevation in 20 patients and isolated amylase elevation in 9 patients. In 20 patients (53%), initial EUS was diagnostic, most common findings were chronic pancreatitis (nZ7; 18%), sludge (5; 13%), and new diagnosis of pancreas divisum (3; 8%). Other results are shown in Figure 1. Of the patients having only elevated lipase, only elevated amylase, or both, each group had all common findings, also with similar rates of nondiagnostic EUS in all three groups. In the asymptomatic patients (7), diagnoses were found in 3 patients, most significant for sludge (2), stone (1), and pancreas divisum (1). No patients were diagnosed with a mass or cyst. Pathology was largely nondiagnostic; 1 patient had H. pylori gastritis. Follow up was available in 27 patients, ranging from 1 month to 10 years, median 3 years. There were 7 patients (26%) who had cholecystectomy during the follow up period. Follow up endoscopy (EUS and/or endoscopic retrograde cholangiopancreatography [ERCP]) most commonly found sludge (5; 19%) or duct stenosis/stricture (4; 15%). Discussion: In our study cohort of patients with isolated elevations in amylase and/or lipase without acute pancreatitis who underwent EUS, approximately half were found to have a pancreaticobiliary diagnosis. The most common findings seen on EUS were chronic pancreatitis or biliary/gallbladder sludge. There were no patients identified with masses, cysts, or pseudocysts. Based on this single center experience, EUS can provide a diagnosis in about 50% of patients presenting with an elevated amylase and/or lipase and no clear etiology.
Figure 1. Endoscopic Ultrasound Results
Su1364 High Yield of Core Tissue for Histological Analysis With High Diagnostic Accuracy of Eus-Fine Needle Biopsy Using the 22G Acquire Needle: A Multicenter Prospective Study Roberto Di Mitri*1, Silvia Carrara2, Carlo Fabbri3, Filippo Mocciaro1, Alessandro Repici2, Guido Costamagna4, Alberto Larghi4 1 Gastroenterology and Endoscopy Unit, ARNAS Civico-DI CristinaBenfratelli Hospital, Palermo, Italy; 2Gastroenterology-Digestive Endoscopy Service, Humanitas Research Hospital, Rozzano (MI), Italy; 3Servizio di
www.giejournal.org
Gastroenterologia ed Endoscopia, Maggiore-Bellaria Hospital, Bologna, Italy; 4Digestive Endoscpy Unit, Università Cattolica del Sacro Cuore, Rome, Italy Introduction: Fine Needle Biopsy (FNB) represents the gold diagnostic standard during Endoscopic Ultrasound (EUS) procedures of pancreatic solid lesions. The evolution of needle characteristics, with novel designs for EUS-guided Fine Needle Biopsy (EUS-FNB), may improve the procurement yield of tissue core biopsy samples and the final diagnostic capability overcoming some of the limitations of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Aims and Methods: We aimed to assess the safety, yield for a histological sample and diagnostic accuracy of the newly developed 22gauge (22G) AcquireTM histology needles. Data from consecutive patients with solid lesions who underwent EUS-FNB using the 22G AcquireTM needles were prospectively retrieved from the database of 4 tertiary care centers. A visible core was defined as an architecturally intact-looking piece of tissue deemed sufficient for histologic evaluation. Samples positive for malignancy were considered diagnostic. For patients with negative EUS-FNB, surgical specimen evaluation, results of other diagnostic investigation and/or long-term clinical follow-up (6 months) were used to establish the definitive diagnosis. Results: During the study period, 48 patients (mean age 67.810,9 years; M/F, 27/ 21) underwent EUS-FNB using the AquireTM needles. Characteristics of the pancreatic masses and of the FNB were reported in table 1. A visible core biopsy sample was obtained in all patients (100%) and only in 1 patient (2%) the pathologist reported an “not much adequate” sample. No difference in term of “adequate specimen” was recorded between patients undergoing 2 or 3 needle passes trough the pancreatic mass, and between the different pancreatic sites of FNB. Among the 48 patients with an analyzable retrieved sample, a diagnosis of malignancy was obtained in 44 cases (92%, “true positive”): 37 adenocarcinoma, 4 pancreatic neuroendocrine carcinoma, 3 metastasis. In 4 patients the suspected final diagnosis was chronic pancreatitis but the clinical history and the short follow-up suggest a prudential approach in 3 of those patients considering the final diagnosis as possible “false negative”. Based on these results the sensitivity, specificity, negative likelihood ratio, positive likelihood ratio, and diagnostic accuracy were 93.6% (95% CI,81.4-98.3), 100% (95% CI, 54.6–100), 0.063 (95% CI, 0.021-0.190), “infinity” (final value >10 with 95% CI not calculable), and 94% (95% CI, 89.1-98.5), respectively. No adverse events were recorded. Conclusions: The 22G AcquireÔ needles are able to gather tissue for EUS-FNA of solid lesions with very good procurement and diagnostic yields after 2 or 3 needle passes. This novel “three pointstip” needle showed very high level of sensitivity, specificity and diagnostic accuracy, with a safe post-biopsy profile.
Su1365 Eus-Elastography With Strain Ratio in the Diagnosis of Solid Pancreatic Lesions: A Single Center Prospective Cohort Study Silvia Carrara*1, Milena Di Leo1, Andrea A. Anderloni1, Alessandro Fugazza1, Laura Poliani1, Paoletta Preatoni1, Alessandro Zerbi2, Alessandro Repici1 1 Gastroenterology, Humanitas Researc Hospital, Rozzano, Italy; 2 Panreatic surgery unit, Humanitas Researc Hospital, Rozzano, Italy Background: EUS elastography is a non-invasive ultrasound technique that displays the relative stiffness of tissues by taking advantage of the deformation caused by the compression or vibrations of the tissues. The level of hardness of solid pancreatic lesions (SPL) can be evaluated using either a qualitative scores and/or quantitative method (strain
Volume 85, No. 5S : 2017 GASTROINTESTINAL ENDOSCOPY AB351
Su1363 The Utility of Endoscopic Ultrasound in Patients With Isolated Serum Elevations in Amylase And/Or Lipase: A Single Center Experience Lalitha Sitaraman*1, Amit H. Sachdev2, Tamas Gonda2, Amrita Sethi2, John M. Poneros2, Frank G. Gress2 1 Medicine, Columbia University, New York, NY; 2Digestive and Liver Diseases, Columbia Unversity, New York, NY Background: Isolated elevations in serum levels of pancreatic enzymes (amylase and lipase) may represent pancreatic or non-pancreatic disease. When patients have elevated levels of amylase and/or lipase, they may be symptomatic or asymptomatic, with such elevations incidentally discovered. The diagnostic yield of endoscopic ultrasound (EUS) in these patients is not well described. Methods: A retrospective chart review was conducted at a large tertiary academic medical center from 2000 to 2016. Patients were selected on the basis of having elevated amylase, lipase, or both, but without a diagnosis of acute pancreatitis or known pancreatobiliary disease. Patients were excluded if they had findings suggestive of another etiology, i.e. abnormal serum aminotransferases, bilirubin, or alkaline phosphatase or abnormal imaging of the pancreas. Results from EUS, pathology, and follow up imaging and/or procedures were recorded. Results: Out of 299 EUS performed between 2000-2016 with the indication of elevated amylase and/or lipase, 38 patients met inclusion criteria. Patients were predominantly female (74%), mean age 50.3 (SD 15.6). Symptoms were present in 31 patients, with the most common symptom being abdominal pain (87%). Both amylase and lipase were elevated in 9 patients, with isolated lipase elevation in 20 patients and isolated amylase elevation in 9 patients. In 20 patients (53%), initial EUS was diagnostic, most common findings were chronic pancreatitis (nZ7; 18%), sludge (5; 13%), and new diagnosis of pancreas divisum (3; 8%). Other results are shown in Figure 1. Of the patients having only elevated lipase, only elevated amylase, or both, each group had all common findings, also with similar rates of nondiagnostic EUS in all three groups. In the asymptomatic patients (7), diagnoses were found in 3 patients, most significant for sludge (2), stone (1), and pancreas divisum (1). No patients were diagnosed with a mass or cyst. Pathology was largely nondiagnostic; 1 patient had H. pylori gastritis. Follow up was available in 27 patients, ranging from 1 month to 10 years, median 3 years. There were 7 patients (26%) who had cholecystectomy during the follow up period. Follow up endoscopy (EUS and/or endoscopic retrograde cholangiopancreatography [ERCP]) most commonly found sludge (5; 19%) or duct stenosis/stricture (4; 15%). Discussion: In our study cohort of patients with isolated elevations in amylase and/or lipase without acute pancreatitis who underwent EUS, approximately half were found to have a pancreaticobiliary diagnosis. The most common findings seen on EUS were chronic pancreatitis or biliary/gallbladder sludge. There were no patients identified with masses, cysts, or pseudocysts. Based on this single center experience, EUS can provide a diagnosis in about 50% of patients presenting with an elevated amylase and/or lipase and no clear etiology.
Figure 1. Endoscopic Ultrasound Results
Su1364 High Yield of Core Tissue for Histological Analysis With High Diagnostic Accuracy of Eus-Fine Needle Biopsy Using the 22G Acquire Needle: A Multicenter Prospective Study Roberto Di Mitri*1, Silvia Carrara2, Carlo Fabbri3, Filippo Mocciaro1, Alessandro Repici2, Guido Costamagna4, Alberto Larghi4 1 Gastroenterology and Endoscopy Unit, ARNAS Civico-DI CristinaBenfratelli Hospital, Palermo, Italy; 2Gastroenterology-Digestive Endoscopy Service, Humanitas Research Hospital, Rozzano (MI), Italy; 3Servizio di
www.giejournal.org
Gastroenterologia ed Endoscopia, Maggiore-Bellaria Hospital, Bologna, Italy; 4Digestive Endoscpy Unit, Università Cattolica del Sacro Cuore, Rome, Italy Introduction: Fine Needle Biopsy (FNB) represents the gold diagnostic standard during Endoscopic Ultrasound (EUS) procedures of pancreatic solid lesions. The evolution of needle characteristics, with novel designs for EUS-guided Fine Needle Biopsy (EUS-FNB), may improve the procurement yield of tissue core biopsy samples and the final diagnostic capability overcoming some of the limitations of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Aims and Methods: We aimed to assess the safety, yield for a histological sample and diagnostic accuracy of the newly developed 22gauge (22G) AcquireTM histology needles. Data from consecutive patients with solid lesions who underwent EUS-FNB using the 22G AcquireTM needles were prospectively retrieved from the database of 4 tertiary care centers. A visible core was defined as an architecturally intact-looking piece of tissue deemed sufficient for histologic evaluation. Samples positive for malignancy were considered diagnostic. For patients with negative EUS-FNB, surgical specimen evaluation, results of other diagnostic investigation and/or long-term clinical follow-up (6 months) were used to establish the definitive diagnosis. Results: During the study period, 48 patients (mean age 67.810,9 years; M/F, 27/ 21) underwent EUS-FNB using the AquireTM needles. Characteristics of the pancreatic masses and of the FNB were reported in table 1. A visible core biopsy sample was obtained in all patients (100%) and only in 1 patient (2%) the pathologist reported an “not much adequate” sample. No difference in term of “adequate specimen” was recorded between patients undergoing 2 or 3 needle passes trough the pancreatic mass, and between the different pancreatic sites of FNB. Among the 48 patients with an analyzable retrieved sample, a diagnosis of malignancy was obtained in 44 cases (92%, “true positive”): 37 adenocarcinoma, 4 pancreatic neuroendocrine carcinoma, 3 metastasis. In 4 patients the suspected final diagnosis was chronic pancreatitis but the clinical history and the short follow-up suggest a prudential approach in 3 of those patients considering the final diagnosis as possible “false negative”. Based on these results the sensitivity, specificity, negative likelihood ratio, positive likelihood ratio, and diagnostic accuracy were 93.6% (95% CI,81.4-98.3), 100% (95% CI, 54.6–100), 0.063 (95% CI, 0.021-0.190), “infinity” (final value >10 with 95% CI not calculable), and 94% (95% CI, 89.1-98.5), respectively. No adverse events were recorded. Conclusions: The 22G AcquireÔ needles are able to gather tissue for EUS-FNA of solid lesions with very good procurement and diagnostic yields after 2 or 3 needle passes. This novel “three pointstip” needle showed very high level of sensitivity, specificity and diagnostic accuracy, with a safe post-biopsy profile.
Su1365 Eus-Elastography With Strain Ratio in the Diagnosis of Solid Pancreatic Lesions: A Single Center Prospective Cohort Study Silvia Carrara*1, Milena Di Leo1, Andrea A. Anderloni1, Alessandro Fugazza1, Laura Poliani1, Paoletta Preatoni1, Alessandro Zerbi2, Alessandro Repici1 1 Gastroenterology, Humanitas Researc Hospital, Rozzano, Italy; 2 Panreatic surgery unit, Humanitas Researc Hospital, Rozzano, Italy Background: EUS elastography is a non-invasive ultrasound technique that displays the relative stiffness of tissues by taking advantage of the deformation caused by the compression or vibrations of the tissues. The level of hardness of solid pancreatic lesions (SPL) can be evaluated using either a qualitative scores and/or quantitative method (strain
Volume 85, No. 5S : 2017 GASTROINTESTINAL ENDOSCOPY AB351