EUS-guided histological specimens from the pancreatic cyst wall

Prof. Borjan Kovacevic (University Hospital Copenhagen, Denmark) showed that obtaining endoscopic ultrasound (EUS)-guided histological specimens from the pancreatic cyst wall was feasible across clinics, although it might be a procedure best reserved for selected patients [1].

EUS-guided histological specimens from the pancreatic cyst wall can be obtained through a through-the-needle microbiopsy forceps, although the value of this instrument has not yet been tested in a multicentre clinical setting. In the presented study, patients referred for EUS evaluation of pancreatic cysts in whom EUS-guided microbiopsy was attempted (n=28) were included from 6 tertiary centres.

The technical success rate was 85.7% (n=24). Biopsies were generally of good quality and contributed to the diagnosis in 20 patients (clinical success of 71.4%). Only 3 adverse events were recorded (10.7%). Technical failure seems to be caused by loss of flexibility of the echoendoscope when both forceps and the FNA needle are inserted. Other technical difficulties described did not hinder procurement of the specimens. Failures were seen in locations where EUS-guided puncture is known to be challenging (i.e. when the echoendoscope was placed in the duodenum). The majority of the procedures was performed using a flexible nitinol needle (n=18/28), but no firm conclusions can be drawn on the potential role of needle flexibility in the ability to obtain biopsy samples with the microbiopsy forceps. Even though no severe or fatal adverse events were recorded, a rate of 10.7% is notable and should be interpreted with caution due to the limited number of patients.

It was concluded that the use of the microbiopsy forceps is feasible with acceptable rates of technical and clinical success across centres. However, the occurrence of adverse events may preclude routine incorporation of this method, and it may be most appropriate to apply only to patients with uncertain cystic lesions where surgery is considered, as these might benefit from this form of extended diagnostics. Prospective studies are warranted to determine the diagnostic potential compared with other modalities.

1. Kovacevic B, et al. UEG Week 2019, Abstract LB10.

Posted on 23 October 201918 March 2021