Preoperative endoscopic ultrasonography‐guided tattooing of the pancreas with a minuscule amount of marking solution using a newly designed injector

Okuzono, Toru; Kanno, Yoshihide; Nakahori, Masato; Aoki, Hayato; Sato, Shun; Matsuda, Tomoki; Chonan, Akimichi

doi:10.1111/den.12675

Cited by 9 publications

(6 citation statements)

References 11 publications

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“…This technique has proved useful for parenchyma-saving pancreatic surgery. [ 34 35 36 ] Moreover, in selected cases, EUS-guided ablation techniques have proven effective in symptomatic functional pNET. [ 37 38 39 40 41 42 43 44 ]…”

Section: Discussionmentioning

confidence: 99%

B-mode and contrast-enhancement characteristics of small nonincidental neuroendocrine pancreatic tumors

et al. 2017

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Background and Objectives:Imaging of the pancreas for detection of neuroendocrine tumors is indicated as surveillance in multiple endocrine neoplasia type 1 (MEN1) or if typical clinical symptoms combined with hormone production raise the suspicion of a neuroendocrine tumor. Endoscopic ultrasound (EUS) is considered the best imaging modality to detect small pancreatic tumors. However, little is known about how small pancreatic neuroendocrine tumors (pNETs) present on EUS.Patients and Methods:In this multicenter study, we retrospectively analyzed the endosonographic characteristics of small pNETs which had been detected due to typical biochemistry and clinical symptoms or during surveillance of MEN 1. Only small pancreatic tumors ≤15 mm with histological confirmation as pNET were included. B-mode and contrast-enhanced ultrasound- and EUS patterns were analyzed.Results:Among 32 patients with histologically proven small pNETs, 7 patients had known MEN1. Among the pNETs, 20 were insulinoma, 2 gastrinoma, 3 glucagonoma, 6 nonfunctional in MEN1, and one PPoma. 94% of the pNET appeared hypoechogenic, only 1 isoechogenic and 1 hyperechogenic. After contrast injection, 90% of the pNETS showed hyperenhancement compared to the surrounding pancreatic parenchyma.Conclusion:The high spatial resolution of EUS allows detection and even cytological confirmation of pNET <7 mm diameter. Hypoechogenicity in B-mode and hyperenhancement after injection of contrast agents are endosonographic characteristics of small pNET and present in >90% of pNETs.

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Section: Discussionmentioning

confidence: 99%

B-mode and contrast-enhancement characteristics of small nonincidental neuroendocrine pancreatic tumors

et al. 2017

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“…In a recent study reporting six patients, among whom there was one with a PanNEN, the authors describe the use of a novel injector capable of delivering a minute amount of dye within a target structure (as small as 0.1 mL) in small aliquots as the needle is retracted 15. However, in one of the cases the marking spot could not be recognized intraoperatively due to the deeper injection from the surface of the pancreatic parenchyma.…”

Section: Eus‐guided Pannens Localization To Guide Surgical Resectionmentioning

confidence: 99%

Interventional endoscopic ultrasound for pancreatic neuroendocrine neoplasms

Rimbaș

Horumba

Rizzatti

et al. 2020

Digestive Endoscopy

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The proximity of the endoscopic ultrasound (EUS) transducer to the pancreas and the possibility to place needles or other accessories into a target located adjacent to the wall of the GI tract have encouraged researchers to develop various EUS‐guided local treatments directed towards pancreatic neuroendocrine neoplasms (PanNENs). The use of pre‐operative EUS‐guided tattooing or fiducial marker placement to facilitate intraoperative tumor localization has proven effective in reducing operative time of laparoscopic surgeries. To reduce the mortality and morbidity rates of surgical resection, which is presently the mainstay treatment of PanNENs. EUS‐guided loco‐regional treatments, such as injection of alcohol and radiofrequency ablation have been proposed and results are hitherto promising. The present paper summarizes currently available data in the field of EUS‐guided interventions to pancreatic neuroendocrine tumors, as well as possible future applications.

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“…Table 1 summarizes all case reports and case series describing the use of EUS-FNT up to now. [ 8 13 14 15 16 17 18 19 20 ] Different techniques and solutions were utilized. After few adverse events (AEs) associated with the use of undiluted unproperly sterilized India ink solution were described in the literature,[ 21 ] Ashida et al .…”

Section: Eus-guided Tattooingmentioning

confidence: 99%

“…Finally, in a retrospective case series of six patients (two of them with lesions located in the pancreatic head), the authors reported the use of a newly developed tool allowing for injection of minuscule amounts of solution. [ 20 ] They used a maximum of 0.1 mL of a viscous solution comprising 4:1 sodium hyaluronate and India ink that was injected while slowly withdrawing the needle, to keep it in a strictly limited area, thus avoiding its leak into the peritoneal cavity or retroperitoneal space. In one of these patients (17%), however, the tattoo could not be identified at surgery, mostly related to the fact that the tattooing solution was injected too deep into the pancreatic parenchyma, which did not allow its recognition on the pancreatic surface.…”

Section: Eus-guided Tattooingmentioning

confidence: 99%

“…The most frequently utilized is the GI Spot ® , a purified and sterilized preparation of carbon black, which is internalized by macrophages without determining any inflammation in surrounding tissues. [ 20 ] The advantage of this solution is related to its carbon particle content, which is nondegradable and remains into the tissues indefinitely, thus creating a permanent tattoo. Differently, when indocyanine green or methylene blue dye is used, EUS-FNT has to be performed time-wise as close as possible to surgery, since these dyes are water soluble and cleared by the organism's cleaning mechanisms.…”

Section: Eus-guided Tattooingmentioning

confidence: 99%

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How to perform EUS-guided tattooing?

et al. 2020

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Recently, we introduced a series of papers describing on how to perform certain techniques and controversies in EUS. In the first paper, “What should be known before performing EUS examinations, Part I,” the authors discussed clinical information and whether other imaging modalities should be needed before embarking in EUS examination. In Part II, some technical controversies on how EUS is performed are discussed from different points of view by providing the relevant available evidence. Herewith, we describe on how to perform EUS-guided fine needle tattooing (FNT) in daily practice. The aim of this paper is to discuss pros and cons for several issues including historical remarks, injecting material, technical approach, and how to perform EUS-FNT including argues in favor and against.

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Preoperative endoscopic ultrasonography‐guided tattooing of the pancreas with a minuscule amount of marking solution using a newly designed injector

Abstract: EUS-tattooing with a minuscule amount of marking solution using the newly developed injector was feasible and seemed useful and relatively safe. Further studies are warranted to confirm the safety and efficacy of EUS-tattooing.

Cited by 9 publications

References 11 publications

B-mode and contrast-enhancement characteristics of small nonincidental neuroendocrine pancreatic tumors

B-mode and contrast-enhancement characteristics of small nonincidental neuroendocrine pancreatic tumors

Interventional endoscopic ultrasound for pancreatic neuroendocrine neoplasms

How to perform EUS-guided tattooing?

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