The Clinical Utility of Evaluating the Luminal Upper Gastrointestinal Tract During Linear Endoscopic Ultrasonography

Kim, Stephen; Hamerski, Chris M.; Ghassemi, Kourosh F.; Shah, Janak N.; Bhat, Yasser M.; Klapman, Jason; Komanduri, Sri; Keswani, Rajesh N.; Bidari, Kiran; Wani, Sachin; Watson, Rabindra R.; Muthusamy, V. Raman

doi:10.1097/mcg.0000000000000434

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…In this study, detection rate of gastric lesions could be increased by brief screening of the stomach. Some studies comparing EUS/ERCP and EGD showed that there was no difference in the rate of missed gastric lesions [14,15]. In contrast, Ashby et al reported that ERCP or EUS followed by EGD resulted in an approximately 20% increase in the detection rate of gastric lesions [7].…”

Section: Discussionmentioning

confidence: 99%

Incidental finding of gastric lesions during endoscopic ultrasonography

Okujima,

Kumagi,

Koizumi

et al. 2024

Preprint

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Background Gastric lesions may be incidentally detected during endoscopic ultrasonography (EUS). We aimed to clarify the detection rate of gastric lesions and the impact of awareness on the detection of gastric lesions during EUS. Methods This retrospective study collected data on age, sex, primary pancreatobiliary disease, indication for EUS and detection of gastric lesions. The detection rate of incidental gastric lesions and documentation of gastric findings was compared between patients who underwent EUS (1,932 procedures, 1,220 patients). A quick gastric screening during EUS was introduced in 2015; therefore, EUS was classified into the former group (2009–2014: 505 procedures, 409 patients) and the latter group (2015–2020: 1,427 procedures, 918 patients). Results Thirteen gastric lesions were incidentally detected during EUS, all in the latter group, including gastric cancer (n = 1), malignant lymphoma (n = 1), gastric adenoma (n = 1), gastric submucosal tumor (n = 2), and gastric ulcer (n = 8). The detection rate of gastric lesions was significantly higher in the latter group than in the former group per procedure (0.91% vs. 0%, P = 0.027) and per patient (1.41% vs. 0%, P = 0.015), and gastric findings were significantly more commonly described in patients’ medical records (39.8% vs. 2.97%, P < 0.001). Conclusions Gastric lesions may be encountered during EUS. A quick screening during EUS improved the detection rate of gastric lesions, presumably due to increased awareness of gastric lesions during the procedure.

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Section: Discussionmentioning

confidence: 99%

Incidental finding of gastric lesions during endoscopic ultrasonography

Okujima,

Kumagi,

Koizumi

et al. 2024

Preprint

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“…In patients undergoing EUS for pancreaticobiliary or mediastinal indications, three studies found clinically relevant luminal lesions of the upper GI tract in 20.5%–29.7% of cases. [106107108] A multicentric prospective study reported that EGD performed prior to EUS found luminal lesions impacting the subsequent endosonography in 9.8% of cases. [107] Therefore, routine performance of EGD before longitudinal EUS may be worthwhile.…”

Section: Do We Need Egd Prior To Eus?mentioning

confidence: 99%

“…[109110] The miss rate of clinically relevant lesions using a longitudinal echoendoscope to evaluate the luminal surface of the upper GI tract in one prospective multicenter study was not inferior to EGD. [108] EGD always requires air insufflation. The removal of insufflated air for EUS may be time-consuming and incomplete.…”

Section: Do We Need Egd Prior To Eus?mentioning

confidence: 99%

What should be known prior to performing EUS?

et al. 2019

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Direct referral of patients for EUS – instead of preprocedural consultation with the endosonographer – has become standard practice (like for other endoscopic procedures) as it is time- and cost-effective. To ensure appropriate indications and safe examinations, the endosonographer should carefully consider what information is needed before accepting the referral. This includes important clinical data regarding relevant comorbidities, the fitness of the patient to consent and undergo the procedure, and the anticoagulation status. In addition, relevant findings from other imaging methods to clarify the clinical question may be necessary. Appropriate knowledge and management of the patients’ anticoagulation and antiplatelet therapy, antibiotic prophylaxis, and sedation issues can avoid unnecessary delays and unsafe procedures. Insisting on optimal preparation, appropriate indications, and clear clinical referral questions will increase the quality of the outcomes of EUS. In this paper, important practical issues regarding EUS preparations are raised and discussed from different points of view.

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Synchronous Esophageal and Gastric Cancer Detected by Iatrogenic Esophageal Mucosal Injury Incurred During Endoscopic Retrograde Cholangiopancreatography

Kim¹,

Hyun²,

Lee³

et al. 2018

Korean J Pancreas Biliary Tract

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Esophageal mucosal tear occurred during scope insertion in a 71-year-old male patient who previously underwent endoscopic retrograde cholangiopancreatography (ERCP) several times without any complications. The mucosal tear was successfully sealed with endoclips using a forward-viewing scope. However, this mishap leads to the incidental discovery of both esophageal cancer and early gastric cancer. Duodenoscope has inherent limitation in observing the gastrointestinal tract, especially the esophagus, and may miss clinically significant lesions. Therefore, in addition to applying sufficient lubricant to the scope tip and considering the possibility of anatomical variation to prevent mucosal injury or perforation, performing upper endoscopy during ERCP should be considered in a certain patient population, albeit the utility of and the population benefiting from it remains to be proven by a large-scale study.

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The Clinical Utility of Evaluating the Luminal Upper Gastrointestinal Tract During Linear Endoscopic Ultrasonography

Abstract: A substantial minority of patients undergoing L-EUS for nonluminal indications will have clinically meaningful luminal findings. The endoscopic evaluation of the luminal upper GI tract can be adequately achieved using the linear echoendoscope.

Cited by 3 publications

References 11 publications

Incidental finding of gastric lesions during endoscopic ultrasonography

Incidental finding of gastric lesions during endoscopic ultrasonography

What should be known prior to performing EUS?

Synchronous Esophageal and Gastric Cancer Detected by Iatrogenic Esophageal Mucosal Injury Incurred During Endoscopic Retrograde Cholangiopancreatography

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