Endoscopy 2019; 51(04): S45
DOI: 10.1055/s-0039-1681303
ESGE Days 2019 oral presentations
Friday, April 5, 2019 11:00 – 13:00: Video EUS 2 South Hall 1A
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC ULTRASOUND-GUIDED BIOPSY OF SUBEPITHELIAL GASTROINTESTINAL LESIONS – JUST WET-IT

I Pita
1   Gastroenterology, Portuguese Institute of Oncology, Porto, Portugal
,
J Fernandes
2   Gastroenterology, Centro Hospitalar Cova da Beira, Covilhã, Portugal
,
P Pimentel-Nunes
1   Gastroenterology, Portuguese Institute of Oncology, Porto, Portugal
,
P Monteiro
3   Pathology, Portuguese Institute of Oncology, Porto, Portugal
,
M Dinis-Ribeiro
1   Gastroenterology, Portuguese Institute of Oncology, Porto, Portugal
,
P Bastos
1   Gastroenterology, Portuguese Institute of Oncology, Porto, Portugal
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Introduction:

Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUSFNAB) is the main method for acquisition of tissue from gastrointestinal subepithelial lesions (SELs). Despite the development of new needles, diagnostic yield remains low. The reason may be an ineffective transmission of negative pressure with the dry technique, as these lesions often have high cellular cohesion. A new method of aspiration has been described, where the needle is filled with saline (wet suction technique, WST), with promising results in pancreatic lesions. This method hasn't been tested in SELs.

Aims and Methods:

Prospective single centre study to assess the diagnostic yield of EUSFNAB+WST in the diagnosis of SELs, without the use of rapid on-site evaluation. In mesenchymal tumours, the diagnosis was considered positive only when immunohistochemistry (IHC) could differentiate between gastrointestinal stromal tumour (GIST) and leiomyoma. The diagnostic yield of this prospective cohort between July 2015 and December 2017 was compared with a retrospective cohort using dry technique from the same institution.

Results:

Seventy-one patients with SELs were included (49% male, mean age 66 years). Mean SEL size was 32 mm (min 10, max 120 mm), mean number of passages was 3 (± 0.7). A 22G needle was used in 58 patients (82%), 19 G in 8 (12%) and 25 G in 5 (7%). We obtained a conclusive cytopathological diagnosis in 60 cases (diagnostic yield of 85%) and IHC was performed in 58 cases (82%). The most frequent diagnoses were GIST (37%), leiomyoma (14%) and metastases (13%). When compared with a retrospective cohort of 56 cases, diagnostic yield was significantly higher (85% versus 25%, p < 0.0001).

Conclusion:

Wet suction technique allowed an excellent diagnostic yield in the EUS-guided evaluation of SELs. We suggest that, after proper replication of these results, WST may become the first-line method in the management of these lesions.