Cross-Sectional Study to Assess Endoscopic Ultrasound Practice in Portugal

Abstract

Background: Despite the increasing number of national departments performing endoscopic ultrasound (EUS), there are no official data regarding clinical EUS practice in Portugal. Objectives: We aimed to evaluate the current practice of EUS in Portugal. Methods: By email, we invited 1 physician of each one of the 26 national Gastroenterology Departments which perform EUS to complete a survey questionnaire available on the Google Forms platform. The online questionnaire was available from September 2017 until February 2018 and was answered only by physicians who perform EUS. Results: A total of 21/26 (80.8%) national Gastroenterology Departments answered the questionnaire. In Portugal, there are 42 echoendoscopes in total; most of the echoendoscopy units have only 1 EUS processor (81%), 1 ra-dial echoendoscope (66.7%), 1 linear echoendoscope (76.2%), 1 anorectal probe (57.1%), but no miniprobes (85.7%). About 81% have histological core acquisition needles. In 81% of the units, there are at least 2 ultrasonographers who perform echoendoscopy together (at least 2 ultrasonographers per EUS) in 47.6% of these departments. The ultrasonographers also performed abdominal ultrasound (US), anal US, and endoscopic retrograde cholangiopancreatography in 71.4, 66.7, and 42.9%, respectively. The echoendoscopy units have 2.4 ± 1.1 periods of echoendoscopy per week and 4 ± 1.5 EUS per period (499.2 ± 416.8 EUS per year). Subepithelial lesions and biliopancreatic lesion evaluation as well as gastrointestinal neoplasia staging were the most common EUS indications. The number of FNA (fineneedle aspirations) ranges from 10 to 160/year. Rapid on-site evaluation (ROSE) is available in 60% of units and is performed by the cytopathologist (66.7%) in the majority of cases. The main reason for omitting ROSE is the limited pathology staff. Cytopathological material is prepared by the ultrasonographer in 25% of the units. Air drying (50%) and formalin (50%) are most frequently used to fix and preserve smears, respectively. Pancreatic pseudocyst drainage (66.7%), celiac plexus neurolysis (52.4%) and pancreatic necrosectomy (42.9%) are the most widespread therapeutic procedures. Conclusions: This survey provides the first insight into the current status of digestive echoendoscopy in Portugal. There is a great variability in diagnostic and therapeutic echoendoscopy practice.

EUS development in China: Results from national surveys in 2013 and 2020

“…After 2010, the proportion of EUS-FNA has increased to 17%–40% in developed countries. [ 5 , 15 , 17 18 19 ] In our study, the volume of interventional EUS increased from 10,737 in 2012 to 15,334 in 2019, but its proportion decreased from 5.18% to 3.30%. Moreover, less than 20% of EUS examinations were indicated for the biliary tract and pancreas in 2019, which was lower than the percentages in developed countries.…”

“…In 2019, the median EUS volume per hospital was 123 (IQR, 39.5–375), and, for the 801 newcomers starting EUS after 2012, the median volume was only 74 (IQR, 28–189), which was much lower than the volume of Spain (median volume: 450) and Portugal (average volume: 499.2). [ 5 , 18 ] The influence of volume on the quality of endoscopy is a concern, and prospective studies have shown that the quality of ERCP is lower in low-volume hospitals or endoscopists. [ 20 , 21 ] Several studies have shown that low volume is a potential risk factor for adverse events of EUS-FNA,[ 22 , 23 ] but not for the EUS-FNA–positive rate for pancreatic lesions.…”