Endoscopy 2009; 41(4): 335-339
DOI: 10.1055/s-0029-1214470
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic-ultrasound-guided mural trucut biopsy in the investigation of unexplained thickening of esophagogastric wall

T.  Thomas1 , P.  V.  Kaye1 , K.  Ragunath1 , G.  P.  Aithal1
  • 1Nottingham Digestive Diseases Centre: BioMedical Research Unit, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, United Kingdom
Weitere Informationen

Publikationsverlauf

submitted11 May 2008

accepted after revision9 December 2008

Publikationsdatum:
01. April 2009 (online)

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.

References

  • 1 Chambers L A, Clark II W E. The endoscopic diagnosis of gastrooesophageal malignancy. A cytologic review.  Acta Cytol. 1980;  24 313-318
  • 2 Andriuli A, Recchia S, De Angelis C. et al . Endoscopic ultrasonographic evaluation of patients with biopsy negative gastric linitis plastica.  Gastrointest Endosc. 1990;  36 611-615
  • 3 Liu W, Fackler W, Rice T W. et al . The pathogenesis of pseudoachalasia: a clinicopathologic study of 13 cases of a rare entity.  Am J Surg Pathol. 2002;  26 784-788
  • 4 Horwhat J D, Paulson E K, McGrath K. et al . A randomized comparison of EUS-guided FNA versus CT or US-guided FNA for the evaluation of pancreatic mass lesions.  Gastrointest Endos. 2006;  63 966-975
  • 5 Williams D B, Sahai A V, Aabakken L. et al . Endoscopic ultrasound guided fine needle aspiration biopsy: a large single centre experience.  Gut. 1999;  44 720-726
  • 6 Lucido M, Lai R, Mallery S. Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in the diagnosis of linitis plastica [abstract].  Dig Endoscopy. 2004;  16 (Suppl 2) A18
  • 7 Wiersema M J, Vilmann P, Giovannini M. et al . Endosonography guided fine needle aspiration biopsy: diagnostic accuracy and complications assessment.  Gastroenterology. 1997;  112 1087-1095
  • 8 Pellise-Urquisa M, Fernandez- E sparrach, Sole M. et al . Endoscopic ultrasound-guided fine needle aspiration: predictive factors of accurate diagnosis and cost-minimization analysis of on-site pathologist.  Gastroenterol Hepatol. 2007;  30 319-324
  • 9 Aithal G P, Anagnostopoulos G K, Kaye P. EUS-guided transmural biopsies in the investigation of unexplained thickening of oesophagogastric wall.  Gastrointest Endosc. 2005;  62 624-629
  • 10 Andriulli A, Recchia S, De Engelis C. et al . Endoscopic ultrasonographic evaluation of patients with biopsy negative gastric linitis plastica.  Gastrointest Endosc. 1990;  36 611-615
  • 11 Wiersema M J, Levy M J, Harewood G C. et al . Initial experience with EUS-guided trucut needle biopsies of perigastric organs.  Gastrointest Endosc. 2002;  56 275-280
  • 12 Varadarajulu S, Fraig M, Schmulewitz N. et al . Comparison of EUS-guided 19-gauge Trucut needle biopsy with EUS-guided fine needle aspiration.  Endoscopy. 2004;  36 397-401
  • 13 Levy M J, Jondal M L, Clain J. et al . Preliminary experience with EUS-guided trucut biopsy compared with EUS-guided FNA.  Gastrointest Endoscopy. 2003;  57 101-106
  • 14 Gress F G, Hawes R H, Savides T J. et al . Endoscopic ultrasound guided fine needle aspiration biopsy using linear array and radial scanning endosonography.  Gastrointest Endoscopy. 1997;  45 243-250
  • 15 Matsui M, Goto H, Niwa Y. et al . Preliminary results of fine needle aspiration biopsy histology in gastrointestinal submucosal tumours.  Endoscopy. 1998;  30 750-755
  • 16 Ando N, Goto H, Niwa Y. et al . Diagnosis of GI stromal tumours with fine needle aspiration with immunohistochemical analysis.  Gastrointest Endosc. 2002;  55 37-43
  • 17 Vander Noot M R, Eloubeidi A M, Chen V K. et al . Diagnosis of gastrointestinal tract lesions by endoscopic ultrasound guided fine needle aspiration biopsy.  Cancer Cytopathlogy. 2004;  102 157-163
  • 18 Chen V K, Eloubeidi M A. Endoscopic ultrasound guided fine needle aspiration cytology of intramural and extraintestinal mass lesions: diagnostic accuracy, complication assessment, and impact on management.  Endoscopy. 2005;  37 984-989
  • 19 Mortensen M B, Pless T, Durup J. et al . Clinical impact of endoscopic ultrasound guided fine needle aspiration biopsy in patients with upper gastrointestinal tract malignancies. A prospective study.  Endoscopy. 2001;  33 478-483
  • 20 Ginès A, Pellise M, Fernández-Esparrach G. et al . Endoscopic ultrasonography in patients with large gastric folds at endoscopy and biopsies negative for malignancy: predictors of malignant disease and clinical impact.  Am J Gastroenterol. 2006;  101 64-69
  • 21 Allum W H, Griffin S M, Watson A. et al . Guidelines for the management of oesophageal and gastric cancer.  Gut. 2002;  50 1-23

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