Comparison between Two Types of 22-Gauge Fine-Needle Biopsy for Solid Pancreatic Tumors.

Background: Tissue sampling using endoscopic ultrasound-guided fine-needle aspiration is the gold standard for diagnosing malignant pancreatic tumors; however, its sensitivity and specificity are highly variable. Thus, fine-needle biopsy using cutting needles has been developed to overcome current limitations and improve diagnostic yield. Our study compared two fine-needle biopsy needles for tissue sampling for pancreatic solid lesions. Materials and Methods: Samples obtained from patients with pancreatic solid lesions using the 22-gauge fine-needle biopsy needles (Franseen needle or reverse bevel needle) were retrospectively analyzed. The primary outcomes were diagnostic yield and sample adequacy. The secondary outcome was diagnostic performance. The analysis was performed using 2 × 2 tables to calculate sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for each needle type. Proportions were compared using the Z test. For quantitative variables, a comparative analysis was performed using Student's t test. Qualitative and unpaired outcome variables were described using Fisher's exact test. Results: Sixty-three patients with pancreatic lesions were included in the analysis. The fine-needle biopsy Franseen and reverse bevel groups included 33 and 30 patients, respectively. An adequate sample was obtained in 97% of patients in the Franseen needle group versus 80% in the reverse bevel needle group; the diagnostic yields in these groups were 93.9 and 66.7%, respectively. Neither differences between needle passes nor complications were noted. The sensitivity and specificity were 93.5 and 100%, respectively, in the fine-needle biopsy Franseen group, versus 71 and 100%, respectively, in the reverse bevel needle group. Conclusions: The Franseen needle was more effective for sampling pancreatic tumors than the reverse bevel needle.

Introdução: A aquisição de tecido através de punção com agulha fina guiada por ecoendoscopia é o padrão para o diagnóstico de neoplasias pancreáticas malignas; contudo, a sua sensibilidade e especificidade é altamente variável. A biópsia por agulha fina (FNB) usando agulhas cortantes foi desenvolvida para ultrapassar as limitações atuais. Este estudo comparou duas agulhas de FNB na aquisição de tecido de lesões pancreáticas sólidas. Métodos: Amostras obtidas de doentes com lesões pancreáticas sólidas utilizando agulha de FND de 22 gauge (Franseen ou reverse bevel) foram avaliadas retrospetivamente. Os outcomes primárias foram a rentabilidade diagnóstica e a adequabilidade das amostras. O outcome secundário foi a performance diagnóstica. A análise estatística foi realizada através de tabelas de contingência 2 × 2 para cálculo da sensibilidade, especificidade, valor preditivo positivo e negativo e acuidade para cada tipo de agulha. As proporções foram calculadas utilizando o teste-Z. Para variáveis quantitativas foi realizada análise comparativa com teste t-Student. Variáveis qualitativas e não pareadas foram comparadas com teste exato de Fisher. Resultados: Foram incluídos 63 doentes com lesões pancreáticas (33 no grupo FNB Franseen e 30 no grupo reverse bevel). Foram obtidas amostras adequadas em 97% do grupo Franseen vs 80% no grupo reverse bevel, sendo a rentabilidade diagnóstica de 93.9 e 66.7%, respetivamente. Não houve diferenças no número de passagens nem nas complicações. A sensibilidade e especificidade foram, respetivamente, de 93.5 e 100% no grupo Franseen versus 71 e 100% no grupo reverse bevel. Conclusões: A agulha Franseen foi mais efetiva na aquisição de amostras de lesões pancreáticas do que a agulha reverse bevel.

Eficacia del endoscopio frontal asistido por cap como método para la evaluación de la ampolla de Vater / Efficacy of cap-assisted forward-viewing endoscopy as a method for the evaluation of the ampulla of Vater

Introducción: la evaluación endoscópica de la ampolla de Vater (AV), aunque recomendada de forma rutinaria, no siempre es posible debido a su configuración anatómica, que puede ocultarla del campo visual del endoscopio frontal. Se ha propuesto como una alternativa eficaz el usoañadido de un cap distal al endoscopio frontal para facilitar la examinación de esta estructura.Objetivos: determinar la eficacia del uso del endoscopio frontal asistido por cap para la valoración completa del AV. Se valoran la morfología del AV, los tiempos de búsqueda y total del procedimiento, así como la seguridad de la técnica.Métodos: estudio prospectivo de un solo brazo con inclusión de los pacientes en quienes se realizó una endoscopia alta electiva. Se excluyeron los pacientes con neoplasia avanzada, anatomía modificada, diagnóstico de estenosis u obstrucción del tracto digestivo superior.Resultados: se analizaron 90 pacientes, 36 hombres (40 %) y 54 mujeres (60 %), un 15,5 % del total con antecedente de un síndrome hereditario para cáncer de colon. El éxito técnico del endoscopio frontal + cap fue del 98,8 %. El AV se clasificó como tipo 1 (clásica) en el 49,4 %; tipo 2 (plana), en el 16,8 %; tipo 3 (protuberante), en el 11,2 %; y tipo 4 (anillada), en el 22,4 %. El tiempo promedio de búsqueda fue de 37,7 segundos (s) (DE ± 31,6), con un tiempo total procedimiento de 487,4 s (DE ± 206,2). No se reportaron eventos adversos.Conclusiones: el uso combinado del endoscopio frontal y cap distal es una técnica efectiva y segura para la visualización completa y caracterización morfológica del AV. (AU)

Efficacy of cap-assisted forward-viewing endoscopy as a method for the evaluation of the ampulla of Vater.

INTRODUCTION: endoscopic evaluation of the ampulla of Vater (AV), although routinely recommended, is not always possible due to its anatomic configuration, which can hide it from the visual field of the forward-viewing endoscope. Cap-assisted forward-viewing endoscopy has been proposed as a useful alternative to facilitate the examination of this structure. OBJECTIVES: to assess the efficacy of cap-assisted forward-viewing endoscopy for the complete evaluation of the AV. Secondary outcomes were to assess AV morphology, search and total procedure times and technique safety. METHODS: a prospective, single-arm study. Patients who were selected for elective upper endoscopy were included. Patients with advanced neoplasia, modified anatomy, upper gastrointestinal stenosis or obstructions were excluded. OUTCOMES: ninety patients were included, 36 males (40 %) and 54 females (60 %). Fifteen percent had a history of hereditary colon cancer syndrome. Technical success of cap-assisted, forward-viewing endoscopy was 98.8 %. AV was classified as type 1 (classic) in 49.4 %, type 2 (small) in 16.8 %, type 3 (protruding) in 11.2 % and type 4 (ridged) in 22.4 %. The mean search time was 37.7 seconds (s) (SD ± 31.6) and the total procedure time was 487.4 s (SD ± 206.2). No adverse events were reported. CONCLUSIONS: cap-assisted forward-viewing endoscopy is an effective and safe technique for the complete visualization and morphologic characterization of the ampulla of Vater.