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. 2024 Oct 15;12(10):E1183-E1189.
doi: 10.1055/a-2417-0580. eCollection 2024 Oct.

Efficacy of EUS-guided keyhole biopsies in diagnosing subepithelial lesions of the upper gastrointestinal tract

Sen Verhoeve  1   2 , Cynthia Verloop  1   2 , Marco Bruno  1 , Valeska Terpstra  3 , Lydi Van Driel  1 , Lars Perk  4 , Lieke Hol  2
Affiliations

Efficacy of EUS-guided keyhole biopsies in diagnosing subepithelial lesions of the upper gastrointestinal tract

Sen Verhoeve et al. Endosc Int Open. .

Abstract

Background and study aims Tissue acquisition is required for diagnosis of subepithelial lesions (SELs). However, obtaining adequate tissue remains challenging. This study investigated an EUS-guided technique using a forceps to create a channel and take multiple biopsies from the center of the lesion, therefore called endoscopic ultrasound-guided keyhole biopsy (EUS-KB). Patients and methods A retrospective cohort study was conducted in 56 patients with SELs in the upper gastrointestinal tract who were scheduled to undergo EUS-KB. The primary aim was to assess diagnostic yield, defined as the percentage of procedures where EUS-KB resulted in a definitive histopathological diagnosis. Furthermore, factors influencing diagnostic yield were investigated. Additional outcomes included technical success and adverse events. Results Technical success was achieved in 55 of 60 biopsies (91.7%). EUS-KB provided a diagnosis in 44 of 55 biopsies (80.0%), histology mostly showing gastrointestinal stromal tumor or leiomyoma. The diagnostic yield was not significantly influenced by the size or location of the SEL. Adverse events occurred in one patient (1.7%). Conclusions EUS-KB is a feasible and safe technique for obtaining a classifying diagnosis for SELs in the upper gastrointestinal tract. It could offer an alternative diagnostic modality, especially in lesions smaller than 20 mm.

Keywords: Endoscopic ultrasonography; Performance and complications; Quality and logistical aspects; Subepithelial lesions; Tissue diagnosis.

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Conflict of interest statement

Conflict of Interest M. J. Bruno has received research grants from Boston Scientific, Cook Medical, Pentax Medical, Interscope, Mylan, and 3M and acted as a consultant for Boston Scientific and Cook Medical. The remaining authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Visual overview of a EUS-KB intervention. a Endoscopic evaluation of the subepithelial lesion. b EUS evaluation of the subepithelial lesion. c After creating a channel trough the mucosa and submucosa, the biopsy forceps is introduced through the “keyhole” until it is certain that the tip is located within the SEL. Subsequently, multiple tissue samples are obtained from within the lesion. d The “keyhole” is closed with one or more clips.
Fig. 2
Fig. 2
Microscopic view of a EUS-KB. a Hematoxylin and eosin-stained tissue sample acquired through EUS-KB. The sample shows a GIST. b A high power field for determining the mitotic index. This example shows two mitoses.
See this image and copyright information in PMC

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