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. 2019 Dec;7(23):719.
doi: 10.21037/atm.2019.11.137.

Endoscopic ultrasonography guided transgastric trans-portal system fine needle aspiration for diagnosing pancreatic head and uncinate process malignancy

Min Wang  1 , Shu Huang  2 , Rong Pei  3 , Jie Lin  4 , Xiujiang Yang  3
Affiliations

Endoscopic ultrasonography guided transgastric trans-portal system fine needle aspiration for diagnosing pancreatic head and uncinate process malignancy

Min Wang et al. Ann Transl Med. 2019 Dec.

Abstract

Background: Endoscopic ultrasonography guided fine needle aspiration (EUS-FNA) is a well-established technique for diagnosing pancreatic malignancy. In general, tissue of pancreatic head and uncinate process lesions is obtained via a transduodenal approach. However, this tissue-acquisition modality is not applicable in cases of pyloric obstruction and duodenal bulb ulceration. The aim of this study is to determine the feasibility and safety of a novel EUS-guided transgastric trans-portal system FNA in the diagnosis of pancreatic head and uncinate process cancer.

Methods: This study retrospectively analyzed 26 consecutive inpatient patients who had undergone EUS-FNA for highly suspected malignancy of pancreatic head or uncinate process between December 2013 and December 2018. EUS-guided transgastric trans-portal vein (trans-PV, n=2) or trans-superior mesenteric vein (trans-SMV, n=24) FNA was performed in the patients under conscious sedation. Feasibility, diagnostic yield and complication rates of the technique were evaluated.

Results: Specimens obtained by EUS-guided transgastric trans-portal system FNA were adequate for cytological evaluation in all 26 patients. Cytological diagnosis of adenocarcinoma was established in 22 patients, while the remaining 4 patients were negative. The diagnostic accuracy, sensitivity and specificity were 92.3%, 91.7% and 100% respectively. No immediate or delayed procedure-related complications were observed.

Conclusions: EUS-guided transgastric trans-portal system FNA is a feasible and probably safe method for diagnosing pancreatic head and uncinate process malignancy. Careful selection of the potential candidates and close periprocedural observation are mandatory.

Keywords: Endoscopic ultrasonography guided fine needle aspiration (EUS-FNA); pancreatic malignancy; transgastric trans-portal system.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Process of EUS-guided transgastric trans-portal system FNA. (A) EUS image of a mass (star) located in the pancreatic head. (B,C,D) Endoscopic ultrasound view of pancreatic mass with needle (arrow head) passing through the superior mesenteric vein (arrow) and into the mass.
See this image and copyright information in PMC

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