Clinical and Technical Guideline for Endoscopic Ultrasound (EUS)-Guided Tissue Acquisition of Pancreatic Solid Tumor: Korean Society of Gastrointestinal Endoscopy (KSGE)

Abstract

Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy (KSGE) appointed a task force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in eight categories intended to help physicians make evidence-based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice.

Comparison between three types of needles for endoscopic ultrasound-guided tissue acquisition of pancreatic solid masses: a multicenter observational study

“…Several modified novel needles specially designed to obtain histologic cores with intact architecture have been announced recently to overcome these limitations of specific needle types 2 . These devices, collectively called FNB needles, have been equipped with the unique shape of a needle tip, which has either a side-fenestrated slot (core trap) or a special geometry of the cutting tip, while standard needles without these reinforcement geometries are classified as FNA needles 3 .…”

Safety and efficacy of endoscopic ultrasound as a diagnostic and therapeutic tool in pediatric patients: a multicenter study

“…Despite its benefits, the application of EUS and EUS-FNA/B in children is still limited, likely due to the lower frequency of GI tumors or pancreaticobiliary diseases in children, the limited awareness among pediatricians of EUS procedures, more incredible difficulty of intubation of the esophagus and duodenum in younger children due to the wide caliber of the scope, the absence of special pediatric endoscopes, and the need for deep sedation or general anesthesia among younger individuals. 6 …”

“…5 Despite its benefits, the application of EUS and EUS-FNA/B in children is still limited, likely due to the lower frequency of GI tumors or pancreaticobiliary diseases in children, the limited awareness among pediatricians of EUS procedures, more incredible difficulty of intubation of the esophagus and duodenum in younger children due to the wide caliber of the scope, the absence of special pediatric endoscopes, and the need for deep sedation or general anesthesia among younger individuals. 6 Although the literature reports that the application of linear echo-endoscopes may be feasible in patients weighing at least 15-25 kg, available data regarding this modality remain limited. 7 Moreover, to date, most studies have focused on the diagnostic role of EUS in pediatrics, 4,8,9 while studies evaluating its therapeutic role are fewer in number.…”

Managing adverse events after endoscopic ultrasound‐guided drainage of the biliary tract and pancreatic fluid collections: Narrative review (with video)

“…The emergence of EUS-guided fine needle aspiration cytology was a watershed event in the evolution of EUS, which then ceased to be exclusively a diagnostic procedure. [1][2][3][4][5][6] The era of interventional EUS began with EUS-guided celiac plexus block 1 and today extends to several advanced procedures, mainly for biopsy, 7,8 as well as for the drainage of pancreatic fluid collections and the biliary tract. [9][10][11][12] However, EUS-guided drainage carries a considerable risk of adverse events (AEs), which occur in approximately 23% of the procedures performed for the drainage of pancreatic fluid collections and 2.5-37.0% of those performed for drainage of the biliary tract.…”