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Interventional EUS Using a Flexible 19-Gauge Needle: An International Multicenter Experience in 162 Patients

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Abstract

Background and Aims

To facilitate access for interventional EUS, flexible (nitinol) 19-G needles have been introduced to permit needle puncture even when the echoendoscope is in an angulated position, such as in the second part of the duodenum. The aims of the study were to evaluate the performance of a flexible 19-G needle during interventional EUS procedures and compare outcomes when the echoendoscope was in the straight versus angulated position.

Methods

A retrospective review was undertaken of 162 consecutive patients that underwent a variety of interventional EUS procedures with a flexible 19-G needle across five centers. Patients were subdivided into categories (straight or angulated) depending on the echoendoscope position used for obtaining access to the area of interest (Fig. 1).

Flexible 19-G needle design. a The needle is able to exit the sheath despite the rotated position. b The needle beveled needle tip

Results

In the entire cohort, needle-specific technical success was achieved in 93.2 %, procedural success in 85.2 %, and overall clinical success in 76.5 % of cases at a mean follow-up of 3.1 months. Needle-specific technical success was similar between the straight and angulated cohorts (94.0 vs. 91.2 %, p = 0.74). Procedural success (86.7 vs. 77.2 %, p = 0.05), and rate of clinical success was similar between the cohorts (83.3 vs. 86.4 %, p = 0.79), respectively. Overall adverse events were noted in 14.2 % of patients with no difference between the straight and angulated cohorts (p = 0.48).

Conclusions

This study demonstrates equivalent technical success, clinical success and safety of using a flexible 19-G needle in straight and angulated endoscope positions for interventional EUS. Therefore, a flexible needle may be considered where an angulated echoendoscope position is encountered.

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References

  1. Varadarajulu S, Bang JY, Sutton BS, et al. Equal efficacy of endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage in a randomized trial. Gastroenterology. 2013;145:583–590.

    Article  PubMed  Google Scholar 

  2. Ishiwatari H, Hayashi T, Yoshida M, et al. EUS-guided celiac plexus neurolysis by using highly viscous phenol-glycerol as a neurolytic agent (with video). Gastrointest Endosc. 2015;81:479–483.

    Article  PubMed  Google Scholar 

  3. Doi S, Yasuda I, Kawakami H, et al. Endoscopic ultrasound guided celiac ganglia neurolysis vs. celiac plexus neurolysis: a randomized multicenter trial. Endoscopy 2013;45:362–369.

  4. LeBlanc JK, Al-Haddad M, McHenry L, et al. A prospective, randomized study of EUS-guided celiac plexus neurolysis for pancreatic cancer: one injection or two? Gastrointest Endosc. 2011;74:1300–1307.

    Article  PubMed  Google Scholar 

  5. Musumba C, Tutticci N, Nanda K, et al. Endosonography-guided drainage of malignant fluid collections using lumen-apposing, fully covered self-expanding metal stents. Endoscopy. 2014;46:690–692.

    Article  PubMed  Google Scholar 

  6. Kahaleh M, Artifon E, Perez-Miranda M, et al. Endoscopic ultrasonography guided drainage: Summary of consortium meeting, May 21, 2012, San Diego, California. World J Gastroenterol. 2015;21:726–741.

    PubMed  PubMed Central  Google Scholar 

  7. Khashab MA, Dewitt J. EUS-guided biliary drainage: is it ready for prime time? Yes! Gastrointest Endosc. 2013;78:102–105.

    Article  PubMed  Google Scholar 

  8. Choi JH, Lee SS. Endoscopic ultrasonography-guided gallbladder drainage for acute cholecystitis: from evidence to practice. Dig Endosc. 2015;27:1–7.

    Article  PubMed  Google Scholar 

  9. Itoi T, Sofuni A, Tsuchiya T, et al. Initial evaluation of a new plastic pancreatic duct stent for endoscopic ultrasonography-guided placement. Endoscopy. 2015;47:462–465.

    Article  PubMed  Google Scholar 

  10. Holt B, Varadarajulu S. Endoscopic ultrasound-guided pelvic abscess drainage (with video). J Hepatobiliary Pancreat Sci. 2015;22:12–15.

    Article  PubMed  Google Scholar 

  11. Khashab MA, Valeshabad AK, Afghani E, et al. A comparative evaluation of EUS-guided biliary drainage and percutaneous drainage in patients with distal malignant biliary obstruction and failed ERCP. Dig Dis Sci. 2015;60:557–565.

    Article  PubMed  Google Scholar 

  12. Artifon EL, Aparicio D, Paione JB, et al. Biliary drainage in patients with unresectable, malignant obstruction where ERCP fails: endoscopic ultrasonography-guided choledochoduodenostomy versus percutaneous drainage. J Clin Gastroenterol. 2012;46:768–774.

    Article  PubMed  Google Scholar 

  13. Romero-Castro R, Ellrichmann M, Ortiz-Moyano C, et al. EUS-guided coil versus cyanoacrylate therapy for the treatment of gastric varices: a multicenter study (with videos). Gastrointest Endosc. 2013;78:711–721.

    Article  PubMed  Google Scholar 

  14. Storm AC, Kumbhari V, Saxena P, et al. EUS-guided angiotherapy. Gastrointest Endosc. 2014;80:164–165.

    Article  PubMed  Google Scholar 

  15. Katanuma A, Itoi T, Baron TH, et al. Bench-top testing of suction forces generated through endoscopic ultrasound-guided aspiration needles. J Hepatobiliary Pancreat Sci. 2015;22:379–385.

    Article  PubMed  Google Scholar 

  16. Varadarajulu S, Bang JY, Hebert-Magee S. Assessment of the technical performance of the flexible 19-gauge EUS-FNA needle. Gastrointest Endosc. 2012;76:336–343.

    Article  PubMed  Google Scholar 

  17. Ramesh J, Bang JY, Hebert-Magee S, et al. Randomized trial comparing the flexible 19G and 25G needles for endoscopic ultrasound-guided fine needle aspiration of solid pancreatic mass lesions. Pancreas. 2015;44:128–133.

    Article  PubMed  Google Scholar 

  18. Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71:446–454.

    Article  PubMed  Google Scholar 

  19. Tyberg A, Karia K, Zerbo S, et al. Endoscopic ultrasonography-guided jejunojejunostomy to facilitate endoscopic retrograde cholangiopancreatography: a minimally invasive option. Gastroenterology. 2015;148:506–507.

    Article  PubMed  Google Scholar 

  20. Ogura T, Sano T, Onda S, et al. Endoscopic ultrasound-guided biliary drainage for right hepatic bile duct obstruction: novel technical tips. Endoscopy. 2015;47:72–75.

    PubMed  Google Scholar 

  21. Song TJ, Kim JH, Lee SS, et al. The prospective randomized, controlled trial of endoscopic ultrasound-guided fine-needle aspiration using 22G and 19G aspiration needles for solid pancreatic or peripancreatic masses. Am J Gastroenterol. 2010;105:1739–1745.

    Article  PubMed  Google Scholar 

  22. Bang JY, Ramesh J, Trevino J, et al. Objective assessment of an algorithmic approach to EUS-guided FNA and interventions. Gastrointest Endosc. 2013;77:739–744.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Chavalitdhamrong D, Draganov PV. Performance characteristics of a new flexible nitinol 19-gauge endoscopic ultrasound-guided fine needle aspiration needle. Gut Liver. 2013;7:756.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Park do H, Jeong SU, Lee BU, et al. Prospective evaluation of a treatment algorithm with enhanced guidewire manipulation protocol for EUS-guided biliary drainage after failed ERCP (with video). Gastrointest Endosc. 2013;78:91–101.

  25. Artifon EL, Marson FP, Gaidhane M, et al. Hepaticogastrostomy or choledochoduodenostomy for distal malignant biliary obstruction after failed ERCP: is there any difference? Gastrointest Endosc. 2015;81:950–959.

    Article  PubMed  Google Scholar 

  26. Varadarajulu S, Bang JY, Phadnis MA, et al. Endoscopic transmural drainage of peripancreatic fluid collections: outcomes and predictors of treatment success in 211 consecutive patients. J Gastrointest Surg. 2011;15:2080–2088.

    Article  PubMed  Google Scholar 

  27. Varadarajulu S, Christein JD, Wilcox CM. Frequency of complications during EUS-guided drainage of pancreatic fluid collections in 148 consecutive patients. J Gastroenterol Hepatol. 2011;26:1504–1508.

    Article  PubMed  Google Scholar 

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Author contributions

Vivek Kumbhari and Mouen A. Khashab developed the concept, wrote, and edited the final manuscript. All other authors were involved in data acquisition and editing and final approval of the manuscript.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins Hospital, 1800 Orleans St, Suite 7125 B, Baltimore, MD, 21205, USA

    Vivek Kumbhari, Alan H. Tieu, Saowanee Ngamruengphong, Mohamad H. El-Zein, Payal Saxena, Linda Howard & Mouen A. Khashab

  2. Endoscopy Unit, Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain

    Irene Peñas, Carlos De la Serna-Higuera & Manuel Perez-Miranda

  3. Division of Gastroenterology and Hepatology, Georgetown University Medical Center, Washington, DC, USA

    Manie Juneja, Fuad Maufa & Nadim Haddad

  4. Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Sandeep Krishnan, Susana Gonzalez & Christopher J. DiMaio

  5. Department of Gastroenterology and Hepatology, Stony Brook School of Medicine, Stony Brook, NY, USA

    Peter V. Renny & Jonathan M. Buscaglia

Authors
  1. Vivek Kumbhari
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  2. Irene Peñas
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  3. Alan H. Tieu
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  8. Mohamad H. El-Zein
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  11. Susana Gonzalez
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  13. Payal Saxena
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  14. Linda Howard
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  16. Jonathan M. Buscaglia
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  17. Manuel Perez-Miranda
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  18. Mouen A. Khashab
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Corresponding author

Correspondence to Alan H. Tieu.

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Conflict of interest

Jonathan M. Bucaglia is a consultant for Boston Scientific. Payal Saxena is a consultant for Boston Scientific and has received consulting fees from Olympus Australia, Cook Medical, Pentax Medical and research support from Cook Medical. Mouen A. Khashab is a consultant for Boston Scientific and Olympus America and has received research support from Cook Medical. All other authors have no relevant disclosures.

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Kumbhari, V., Peñas, I., Tieu, A.H. et al. Interventional EUS Using a Flexible 19-Gauge Needle: An International Multicenter Experience in 162 Patients. Dig Dis Sci 61, 3552–3559 (2016). https://doi.org/10.1007/s10620-016-4327-7

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  • DOI: https://doi.org/10.1007/s10620-016-4327-7

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