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DOI: 10.1055/s-0029-1214470
© Georg Thieme Verlag KG Stuttgart · New York
Endoscopic-ultrasound-guided mural trucut biopsy in the investigation of unexplained thickening of esophagogastric wall
Publication History
submitted11 May 2008
accepted after revision9 December 2008
Publication Date:
01 April 2009 (online)
![](https://www.thieme-connect.de/media/endoscopy/200904/lookinside/thumbnails/10.1055-s-0029-1214470-1.jpg)
Background and aims: Esophageal and/or gastric wall thickening raises the possibility of malignancy. Endoscopic-ultrasound-(EUS-)guided targeted biopsy of the thickened wall is possible. We aimed to evaluate the efficacy and safety of EUS-guided mural trucut biopsies (TCB) in detecting underlying malignancy in patients with thickened esophagogastric wall and negative mucosal biopsies.
Methods: Patients with alarm symptoms referred for EUS-guided sampling after negative endoscopy and mucosal biopsy were included in the study. All patients had radial EUS reporting abnormal thickening of the esophageal/gastric wall. A linear-array echoendoscope and a 19-gauge trucut needle were used for sampling. Clinical and investigatory data were collected prospectively between 2004 and 2008.
Results: Thirty-one patients (20 men) aged 60 – 74 years (median 67 years) were included. All patients had thickened esophageal wall (n = 10), gastric wall (n = 21), or both on radial EUS. Prior to EUS, patients had undergone 1 – 5 endoscopies (median 1.2) and 2 – 8 mucosal biopsies (median 4). The median esophageal and gastric wall thicknesses were 12 and 18 mm respectively. During sampling 1 – 5 needle punctures (median 3) were made. On EUS-TCB, an adequate specimen for histology was obtained in 28/31 patients (90 %). The size of the tissue cores was 4 – 10 mm (median 6mm). Malignancy was confirmed in 16/31 patients (54 %) on histology, and in 11/31 patients (35.4 %) an underlying malignancy was excluded. There was no significant correlation between wall thickness and biopsy size (ρ = 0.11, 95 %CI– 0.25 to – 0.45, two-sided P = 0.53). EUS-TCB had sensitivity, specificity, and positive and negative predictive values of 85 %, 100 %, 100 %, and 74 % respectively. There were no immediate or late complications.
Conclusions: EUS-guided mural TCB is a safe and effective technique in the investigation of esophagogastric wall thickening in patients with alarm symptoms and has high sensitivity and specificity for the diagnosis of a cancer.
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G. P. AithalMD, FRCP
South Block, D Floor
Queens Medical Centre Campus
Nottingham University Hospital NHS Trust
Nottingham
NG7 2UH
United Kingdom
Fax: +44-115-9709012
Email: guru.aithal@nuh.nhs.uk