Abstract
Background
Trucut biopsy (TCB) has been proposed to overcome the limitations of endoscopic ultrasonography (EUS)-guided fine-needle aspiration for the pathologic diagnosis of upper gastrointestinal (GI) subepithelial tumor (SET); however, it can be difficult to perform because the Trucut biopsy needle is very stiff. Although technical failures have been reported with the use of TCB, recently the forward-viewing echoendoscope showed a high diagnostic accuracy. We hypothesized that TCB under a conventional forward-viewing endoscope can be applied with higher yield of tissue diagnosis.
Methods
To evaluate the feasibility of TCB under a forward-looking endoscopy without cumbersome EUS guidance, we introduced a 19-gauge TCB needle into the working channel of a conventional upper endoscope in 27 patients with GI SET to make tissue diagnosis. Prospectively collected data were analyzed, including technical success rate, pathologic result, and adverse events.
Results
Twenty-seven patients with GI SET (18 esophageal tumors and nine gastric tumors) underwent TCB under a forward-looking endoscope. All procedures were performed safely without any TCB-related complications. Subsequently, histopathology examination revealed gastrointestinal stromal tumors (GISTs) in three cases and leiomyomas in 21 cases. Histologic assessment was completed in 24 out of 27 patients (88.9 %) because tissue obtained from three patients, whose tumors were located in the stomach, was not sufficient for the pathologic diagnosis.
Conclusions
TCB using a conventional forward-viewing endoscope without EUS guidance provided an excellent pathologic diagnosis of upper GI SET.
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Weon Jin Ko, Ga Won Song, Ki Baik Hahm, Sung Pyo Hong, Joo Young Cho, Jun-Hyung Cho, and So Young Jin have no conflicts of interest or financial ties to disclose.
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This study was conducted in accordance with the ethical standards of the Declaration of Helsinki 1964, as revised in 2013.
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Trucut biopsy using a forward-viewing endoscope without endoscopic ultrasonography guidance for the diagnosis of esophageal subepithelial tumors (WMV 10538 kb)
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Ko, W.J., Song, G.W., Hahm, K.B. et al. Tissue diagnosis of GI subepithelial tumor only through Trucut biopsy under a forward-viewing endoscope: applicability as newer diagnostic modality. Surg Endosc 30, 5009–5014 (2016). https://doi.org/10.1007/s00464-016-4846-5
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DOI: https://doi.org/10.1007/s00464-016-4846-5