Extended application of the Olympus linear echobronchovideoscope (BF-UC160F-OL8) in the upper gastrointestinal tract – Study on visualization of the celiac axis and EUS-FNA of lymph nodes beyond the stenosis in esophageal cancers

Introduction: Malignant lymph nodes (LN) in esophageal cancer (EC) necessitate neoadjuvant chemo- and/or radiotherapy for curative surgery. However, cytological diagnosis is often impossible due to inability to perform LN EUS-FNA beyond non-traversable stenosis with linear echoendoscopes (ø 11.8mm). Aim: To study the ability of the linear echobronchovideoscope (CEBUS) to visualize the celiac axis (CA) and passage through stenotic EC for CEBUS-guided FNA of LN. Method: Consecutive patients with no surgical history who underwent EUS for non-EC indications were recruited for the CA study (Group A); patients with stenotic EC for the EUS-FNA study (Group B). (1) CEBUS (ø 6.2mm) was inserted transorally up to 50cm to visualize CA. (2) For patients with stenotic EC, a pediatric gastroscope was first used to place a 0.035“ guidewire. A 5F Teflon catheter was inserted through the working channel of CEBUS to enable retrograde insertion of guidewire through CEBUS. After the guidewire appeared, CEBUS was then carefully advanced over the guidewire through the stenosis. (3) EUS-FNA was performed on LN beyond the stenosis using TBNA needle. Results: 17 patients were recruited for the CA study (12M:5F; median age 62.7 years, range 43.6–86.6) (A). Two patients had EC, both with non-traversable stenosis (B). In Group A, CA was visualized in 15/17 (88.2%) patients. No difficulty in intubation was encountered. The median length of the scope was 48cm (range 41–50) upon CA visualization. In Group B, CEBUS was passed through the stenosis with EUS-FNA of LN successfully performed in the 2 patients. There was no complication. Conclusion: CEBUS was able to visualize CA in the majority of patients. CEBUS and CEBUS-guided FNA were feasible in patients with stenotic EC without the need for predilation. Despite the floppy shaft of CEBUS, narrow viewing angle and less echo-penetration, FNA of LN was feasible.