Echoendoscope

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Kenji Yamao - One of the best experts on this subject based on the ideXlab platform.

  • stent migration into the peritoneal cavity following endoscopic ultrasound guided hepaticogastrostomy
    Endoscopy, 2015
    Co-Authors: Nozomi Okuno, Kazuo Hara, Nobumasa Mizuno, Susumu Hijioka, Hiroshi Imaoka, Kenji Yamao
    Abstract:

    It is not always possible to perform endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound-guided biliary drainage (EUS-BD) has been performed as an alternative to percutaneous or surgical approaches [1,2]. The 2008 EUS Working Group summarized the indications, techniques, and complications of EUS-guided hepaticogastrostomy (EUS-HGS) [3]. The rate of complications reported for EUS-BD performed by experts was 0%–30%. Major complications included stent migration, bile leakage, peritonitis, and cholangitis [3,4]. A 58-year-old man had unresectable pancreatic cancer. He had undergone EUSguided choledochoduodenostomy and duodenal stent placement. Because obstructive jaundice was recurrent, EUSHGSwasperformedwith thepatient’s consent. A linear EUS scope was used. The intrahepatic bile duct (B3) was punctured with a 19-gauge needle (SonoTip Pro Control 19G; Medi-Globe GmbH, Rosenheim, Germany; Medico’s Hirata Inc., Osaka, Japan). After contrast mediumwas injected, a 0.025-inch guide wire (VisiGlide; Olympus Medical Systems, Tokyo, Japan) was introduced through the needle and placed into the common bile duct. The fistulawas dilated using a 9-Fr tapered biliary dilation catheter (Soehendra biliary dilation catheter; Cook Endoscopy; Bloomington, Indiana, USA). Finally, a fully covered metallic stent (8mm×8cm Wallflex; Microvasive Endoscopy, Boston Scientific, Natick, Massachusetts, USA) was placed. Inward stent migration occurred immediately (●" Fig.1), which would be a fatal complication [4,5], and thereafter open surgical drainage was performed (●" Fig.2). Fortunately, the man was able to resume oral intake after surgery; however, 44 days later, he died as a result of peritonitis carcinomatosa. Anatomically, the stomach is not directly attached to the liver, and during EUS-HGS there is no space between these organs when the Echoendoscope is pressed against the stomach wall. Pulling back the Echoendoscope for stent placement creates space between the liver and stomach wall. Given this complication, stents with lengths of 10 or 12cm should be used to avoid inward stent migration.

  • prospective clinical study of endoscopic ultrasound guided choledochoduodenostomy with direct metallic stent placement using a forward viewing Echoendoscope
    Endoscopy, 2013
    Co-Authors: Kazuo Hara, Nobumasa Mizuno, Susumu Hijioka, Hiroshi Imaoka, Kenji Yamao, Masahiro Tajika, Shin Haba, Shinya Kondo, T Tanaka, O Takeshi
    Abstract:

    A prospective clinical study was conducted to evaluate the safety, feasibility, and efficacy of endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS) with direct metallic stent placement using a prototype forward-viewing Echoendoscope. The indication for EUS – CDS in this study was lower biliary obstruction only, and not failed endoscopic biliary drainage, because the aim was to evaluate EUS – CDS for first-line biliary drainage therapy. The technical and functional success rates were 94 % (17 /18) and 94 % (16 /17), respectively. Early complications (focal peritonitis) were encountered in two patients (11 %). No patients developed late complications. EUS – CDS with direct metallic stent placement using a forward-viewing Echoendoscope was generally feasible and effective for malignant distal biliary tract obstruction. The forward-viewing Echoendoscope was useful, especially for deploying the metallic stent.

  • interventional endoscopic ultrasonography
    Journal of Gastroenterology and Hepatology, 2009
    Co-Authors: Kenji Yamao, Nobumasa Mizuno, Vikram Bhatia, Akira Sawaki, Yasuhiro Shimizu, Atsushi Irisawa
    Abstract:

    Endoscopic ultrasonography (EUS) is the combination of endoscopy and intraluminal ultrasonography. This allows use of a high frequency transducer, which, due to the short distance to the target lesion, enables ultrasonographic images of high resolution to be obtained. Endoscopic ultrasonography is now a widely accepted modality for the diagnosis of pancreatobiliary diseases. It can be used to determine the depth of invasion of gastrointestinal malignancies, and often for visualizing lesions more precisely than other imaging modalities. The most important early limitation of EUS was the lack of specificity in the differentiation between benign and malignant changes. In 1992, EUS-guided fine needle aspiration (EUS-FNA) of lesions in the pancreas head has been made possible using a curved linear array Echoendoscope. Since then, many researchers have expanded the indication of EUS-FNA to various kinds of lesions and also for a variety of therapeutic purposes. In this review, we particularly focus on the present and future roles of interventional EUS, including EUS-FNA and therapeutic EUS.

  • eus guided choledochoduodenostomy for palliative biliary drainage in patients with malignant biliary obstruction results of long term follow up
    Endoscopy, 2008
    Co-Authors: Kenji Yamao, Nobumasa Mizuno, Vikram Bhatia, Akira Sawaki, Hideki Ishikawa, Masahiro Tajika, Noriyuki Hoki, Yasuhiro Shimizu, R Ashida, Norio Fukami
    Abstract:

    Five patients with obstructive jaundice caused by malignant periampullary biliary stenosis underwent EUS-guided choledochoduodenostomy (EUS-CDS) from the first portion of the duodenum using a convex Echoendoscope and a needle knife. All the steps of the procedure including passage dilatation and the plastic stent placement were performed through the accessory channel of the Echoendoscope over the guide wire. Stent insertion was technically successful in all five patients. The procedure was also clinically effective in relieving jaundice in all cases. One patient developed pneumoperitoneum, which resolved with conservative management. Stent exchange was successful in seven of eight attempts in patients with stent occlusion. One failure was due to tumor invasion to the choledochoduodenal fistula. Stent patency was maintained in the remaining patients throughout their survival period. The average stent patency was 211.8 days. EUS-CDS from the first portion of the duodenum appears to be feasible and safe in cases of obstructive jaundice caused by distal bile duct obstruction.

  • standard imaging techniques of endoscopic ultrasound guided fine needle aspiration using a curved linear array Echoendoscope
    Digestive Endoscopy, 2007
    Co-Authors: Kenji Yamao, Mitsuhiro Kida, Shomei Ryozawa, Atsushi Irisawa, Yoshiki Hirooka, Hiroyuki Inoue, Koji Matsuda, Teruo Kozu
    Abstract:

    Standard imaging techniques using a curved linear array echoendocope are summarized to facilitate the attainment of expertise in endoscopic ultrasonography and endoscopic ultrasound-guided fine needle aspiration, and to promote the widespread use of this diagnostic and therapeutic tool. Typical images of the mediastinal organs, the bilio-pancreatic systems and neighboring organs by scanning from the esophagus, stomach, duodenal bulb, and descending portion of the duodenum, are shown in a sequential manner. The basic techniques of endoscopic ultrasound-guided fine needle aspiration are also presented.

Alberto Larghi - One of the best experts on this subject based on the ideXlab platform.

  • forward viewing linear Echoendoscope a new option in the endoscopic ultrasound armamentarium with video
    Journal of Hepato-biliary-pancreatic Sciences, 2015
    Co-Authors: L Fuccio, Fabia Attili, Alberto Larghi
    Abstract:

    The forward-viewing linear Echoendoscope (FV-EUS) has been developed with the aim of overcoming limitations of standard curved linear-array Echoendoscopes (CLA-EUS) and to further expand interventional applications of EUS. The main characteristic of the FV-EUS is a shifting in the orientation of both endoscopic and ultrasound views from oblique to forward, with the exit of the working channel at the tip of the instrument. This allows exit of the devices parallel to the longitudinal axis of the endoscope, thus resulting in a more direct and stable access to the lesion while increasing the precision and force applied to the target. Accumulating evidence has shown that the FV-EUS can be used instead of the standard CLA-EUS scope for routine fine needle aspiration, with extremely good performance for subepithelial lesions and for difficult to reach locations. Several areas of use of this Echoendoscope are yet to be better defined, such as its potential for therapeutic and interventional procedures, as well as for natural orifice transluminal endoscopic surgery. The current report provides an updated overview of the available evidence for both diagnostic and interventional uses of the FV-EUS.

  • endoscopic ultrasound guided fine needle tissue acquisition from a subepithelial lesion in the distal ileum using the forward viewing Echoendoscope
    Endoscopy, 2014
    Co-Authors: Domenico Galasso, Fabia Attili, Franco Scaldaferri, Giuseppe Vanella, Frediano Inzani, Guido Costamagna, Alberto Larghi
    Abstract:

    In a context of rapidly expanding indications for endoscopic ultrasound (EUS)guided procedures, a dedicated forwardviewing linear therapeutic Echoendoscope (FV-EUS) has been developed and tested for different clinical indications [1–3]. The frontal endoscopic view combined with the exit of the working channel at the tip of the Echoendoscope offers some unique advantages over the standard curvilinear Echoendoscope. This has opened up new possibilities for EUS-guided fineneedle aspiration and tissue acquisition (EUS-FNTA) from difficult targets and combined endoscopic/EUS treatment [3, 4]. We have previously described the possibility of using FV-EUS to navigate easily through the colon to reach and sample extracolonic lesions located above the sigmoid tract [4]. We now report the first case of intubation of the ileocecal valve followed by sampling of a distal ileal lesion performed using the FV-EUS. A 68-year-old woman with a 13-year history of ulcerative colitis was found on routine surveillance colonoscopy to have a 1.5cm lesion in the terminal ileum that presented characteristics suggestive of a subepithelial lesion with a normal-appearing overlyingmucosal layer (●" Fig.1). To exclude extrinsic compression, computed tomography was carried out and confirmed the presence of a wall thickening or lesion at the level of the terminal ileum, close to the ileocecal valve. Colonoscopy using the FV-EUS was attempted and was completed up to the cecum. The terminal ileumwas then intubated and, under EUS guidance, a hypoechoic lesion measuring 14×10mm and confined to the thirdwall layer was detected. EUS-FNTAusinga 19-gaugeneedlewas performed (●" Fig.2, ●" Video1) and a tissue sample obtained (●" Fig.3), which revealed a serotonin-secreting neuroendocrine tumor with a Ki67 proliferation index of less than 1%, corresponding to a grade 1 tumor (NET G1). The patient underwent right hemicolectomy, and definitive assessment of the surgical specimen confirmed the diagnosis of a grade 1 serotonin-secreting neuroendocrine tumorwith lymphnode involvement (pT3N1) [5].

  • performance of the forward viewing linear Echoendoscope for fine needle aspiration of solid and cystic lesions throughout the gastrointestinal tract a large single center experience
    Surgical Endoscopy and Other Interventional Techniques, 2014
    Co-Authors: Alberto Larghi, Fabia Attili, Domenico Galasso, Lorenzo Fuccio, Ester Diana Rossi, Matteo Napoleone, Guido Fadda, Guido Costamagna
    Abstract:

    Background A newly developed forward-viewing linear Echoendoscope (FV-EUS) has recently become available. To date, however, only scanty data on the performance of the FV-EUS scope for fine-needle aspiration (FNA) of lesions throughout the gastrointestinal (GI) tract are available. This study aimed to evaluate the technical performance of the FV-EUS scope for FNA of solid and cystic lesions located throughout the GI tract in a large cohort of patients referred to a tertiary care center.

  • fine needle tissue acquisition from subepithelial lesions using a forward viewing linear Echoendoscope
    Endoscopy, 2013
    Co-Authors: Alberto Larghi, Fabia Attili, Giuseppe Vanella, Lorenzo Fuccio, Matteo Napoleone, Gaia Chiarello, Giovanni Battista Paliani, Guido Rindi, Luigi Maria Larocca, Guido Costamagna
    Abstract:

    Background and study aims: The overall diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS – FNA) for subepithelial lesions (SELs) is suboptimal. The aim of this study was to evaluate the diagnostic accuracy, defined as the proportion of correct diagnoses, obtained using the EUS-guided fine-needle tissue acquisition (FNTA) sampling technique performed with the newly developed forward-viewing EUS scope (FV-EUS). Patients and methods: This was a retrospective analysis of a prospectively collected database including all consecutive patients with SELs who underwent EUS – FNTA using the FV-EUS scope from 2007 to 2011 in a tertiary referral center. All procedures were performed by a single expert endoscopist. Results: A total of 121 consecutive patients with SELs (13 in the esophagus, 96 in the stomach, 10 in the duodenum, 2 in the rectum) underwent sampling of the lesion using the FV-EUS scope. The procedure was technically feasible in all but one patient, and no complication related to EUS – FNTA occurred. Full histological assessment including immunostaining could be completed in 93.4 % (113 /121) of the patients. Considering neoplastic vs. non-neoplastic diseases, the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 92.8 % (95 %CI 86.3 – 96.8), 100 % (95 %CI 69.0 – 100 %), infinity, and 0.07 (95 %CI 0.04 – 0.14), respectively. Conclusions: EUS – FNTA performed in conjunction with the FV-EUS scope for sampling SELs of the gastrointestinal tract was safe and provided a very high diagnostic accuracy. Studies comparing FV-EUS with standard curved linear Echoendoscopes are needed to clarify whether these results are due to the sampling technique or the type of scope utilized.

Atsushi Irisawa - One of the best experts on this subject based on the ideXlab platform.

  • Case Report of a Small Gastric Neuroendocrine Tumor in a Deep Layer of Submucosa With Diagnosis by Endoscopic Ultrasound-Guided Fine-Needle Aspiration and Treatment With Laparoscopic and Endoscopic Cooperative Surgery
    SAGE Publishing, 2018
    Co-Authors: Ryo Igarashi, Atsushi Irisawa, Goro Shibukawa, Ai Sato, Nobutoshi Soeta, Akane Yamabe, Mariko Fujisawa, Noriyuki Arakawa, Yoshitsugu Yoshida, Tsunehiko Ikeda
    Abstract:

    Gastric neuroendocrine tumors (GNETs) are rare lesions characterized by enterochromaffin-like cells of the stomach. Optimal management of GNETs has not yet been definitively determined. Endoscopic resection is approximately recommended for small GNETs associated with hypergastrinemia. However, endoscopic resection might present risk of perforation or positive vertical margin because neuroendocrine tumors occur in the deep mucosa, with some invading the submucosa. In this case, a patient with type A chronic atrophic gastritis had a small subepithelial lesion in a deep submucosal layer, and we diagnosed it as GNET using endoscopic ultrasound-guided fine-needle aspiration biopsy using a forward-viewing and curved linear-array Echoendoscope. Moreover, our results show that laparoscopic and endoscopic cooperative surgery with regional lymph node dissection is a safe and feasible procedure for GNETs, especially those that cross to the muscularis propria. We suggest this approach as one therapeutic option for GNETs because it safely minimizes resection and is less invasive

  • an electronic radial scanning Echoendoscope is superior to a mechanical radial scanning Echoendoscope in ultrasound image quality for gastrointestinal tract and pancreaticobiliary lesions
    Fukushima journal of medical science, 2010
    Co-Authors: Takuto Hikichi, Atsushi Irisawa, Tadayuki Takagi, Goro Shibukawa, Takeru Wakatsuki, Hidemichi Imamura, Yuta Takahashi, Ai Sato, Masaki Sato, Tsunehiko Ikeda
    Abstract:

    [Purpose] To objectively compare the electronic radial scanning Echoendoscope (ER-ES) with the mechanical radial scanning Echoendoscope (MR-ES) in the quality of endoscopic ultrasonography (EUS) images of gastrointestinal tract and pancreaticobiliary lesions. [Methods] Studied were 56 patients: 20 with gastric cancer, 20 with gallbladder lesions, and 16 with intraductal papillary-mucinous neoplasms of the pancreas (IPMN). They were subjected to EUS, half of them using the ER-ES, and the other half using the MR-ES. EUS images thus obtained were evaluated concerning four items in patients with gastric cancer and those with gallbladder lesions, and three items in patients with IPMN. Six endosonographers blindly assessed two EUS images per patient on a visual analogue scale. In each of the three groups of patients, the evaluators' median scores for the ER-ES and MR-ES for each item were compared. [Results] The median scores for the ER-ES were significantly higher than those for the MR-ES in all items in patients with gastric cancer and those with IPMN, and in one item in patients with gallbladder lesions. [Conclusion] The ER-ES is certainly superior to the MR-ES in the quality of EUS images of gastrointestinal tract and pancreaticobiliary lesions.

  • preliminary experience of a prototype forward viewing curved linear array Echoendoscope in a training phantom model
    Digestive Endoscopy, 2010
    Co-Authors: Hiroshi Imaizumi, Atsushi Irisawa
    Abstract:

    Oblique-viewing curved linear array (OV-CLA) Echoendoscopes have been widely used to perform endoscopic ultrasonography-guided fine needle aspiration and interventional endoscopic ultrasonography. Recently a prototype forward-viewing curved liner array (FV-CLA) Echoendoscope was developed. In the present trial, 11 endoscopists participated in a hands-on trial and a questionnaire survey to evaluate the operation performance and visualization performance of a prototype FV-CLA scope in a phantom model designed for training of endoscopic ultrasonography. The results of our trial suggested that the FV-CLA scope is slightly inferior or equivalent to the conventional OV-CLA scope in operation performance, and that the FV-CLA scope is equivalent to the OV-CLA scope with regard to the visualization performance in a phantom model.

  • feasibility of interventional endoscopic ultrasound using forward viewing and curved linear array Echoendoscope a literature review
    Digestive Endoscopy, 2010
    Co-Authors: Atsushi Irisawa, Hiroshi Imaizumi, Takuto Hikichi, Tadayuki Takagi, Hiromasa Ohira
    Abstract:

    Oblique-viewing curved linear-array Echoendoscopes are widely used for interventional endoscopic ultrasound (EUS), not only for diagnostic but also for therapeutic procedures. Recently, development of a forward-viewing curved linear-array Echoendoscope (FV-ES) has been made. Several reports describe the usefulness of this new equipment for therapeutic interventional EUS, especially for pseudocyst drainage. A salient advantage of the FV-ES is that it enables the axial application of force during needle insertion and stenting. Furthermore, by attaching a cap device to the tip, the endoscope's capability can be expanded. Although the FV-ES has a narrower scanning range (90 deg) than that afforded by the oblique-viewing curved linear-array Echoendoscope (180 deg), this characteristic reportedly does not hinder the performance of interventional EUS. The FV-ES might contribute to the advancement of interventional EUS.

  • interventional endoscopic ultrasonography
    Journal of Gastroenterology and Hepatology, 2009
    Co-Authors: Kenji Yamao, Nobumasa Mizuno, Vikram Bhatia, Akira Sawaki, Yasuhiro Shimizu, Atsushi Irisawa
    Abstract:

    Endoscopic ultrasonography (EUS) is the combination of endoscopy and intraluminal ultrasonography. This allows use of a high frequency transducer, which, due to the short distance to the target lesion, enables ultrasonographic images of high resolution to be obtained. Endoscopic ultrasonography is now a widely accepted modality for the diagnosis of pancreatobiliary diseases. It can be used to determine the depth of invasion of gastrointestinal malignancies, and often for visualizing lesions more precisely than other imaging modalities. The most important early limitation of EUS was the lack of specificity in the differentiation between benign and malignant changes. In 1992, EUS-guided fine needle aspiration (EUS-FNA) of lesions in the pancreas head has been made possible using a curved linear array Echoendoscope. Since then, many researchers have expanded the indication of EUS-FNA to various kinds of lesions and also for a variety of therapeutic purposes. In this review, we particularly focus on the present and future roles of interventional EUS, including EUS-FNA and therapeutic EUS.

Guido Costamagna - One of the best experts on this subject based on the ideXlab platform.

  • endoscopic ultrasound guided fine needle tissue acquisition from a subepithelial lesion in the distal ileum using the forward viewing Echoendoscope
    Endoscopy, 2014
    Co-Authors: Domenico Galasso, Fabia Attili, Franco Scaldaferri, Giuseppe Vanella, Frediano Inzani, Guido Costamagna, Alberto Larghi
    Abstract:

    In a context of rapidly expanding indications for endoscopic ultrasound (EUS)guided procedures, a dedicated forwardviewing linear therapeutic Echoendoscope (FV-EUS) has been developed and tested for different clinical indications [1–3]. The frontal endoscopic view combined with the exit of the working channel at the tip of the Echoendoscope offers some unique advantages over the standard curvilinear Echoendoscope. This has opened up new possibilities for EUS-guided fineneedle aspiration and tissue acquisition (EUS-FNTA) from difficult targets and combined endoscopic/EUS treatment [3, 4]. We have previously described the possibility of using FV-EUS to navigate easily through the colon to reach and sample extracolonic lesions located above the sigmoid tract [4]. We now report the first case of intubation of the ileocecal valve followed by sampling of a distal ileal lesion performed using the FV-EUS. A 68-year-old woman with a 13-year history of ulcerative colitis was found on routine surveillance colonoscopy to have a 1.5cm lesion in the terminal ileum that presented characteristics suggestive of a subepithelial lesion with a normal-appearing overlyingmucosal layer (●" Fig.1). To exclude extrinsic compression, computed tomography was carried out and confirmed the presence of a wall thickening or lesion at the level of the terminal ileum, close to the ileocecal valve. Colonoscopy using the FV-EUS was attempted and was completed up to the cecum. The terminal ileumwas then intubated and, under EUS guidance, a hypoechoic lesion measuring 14×10mm and confined to the thirdwall layer was detected. EUS-FNTAusinga 19-gaugeneedlewas performed (●" Fig.2, ●" Video1) and a tissue sample obtained (●" Fig.3), which revealed a serotonin-secreting neuroendocrine tumor with a Ki67 proliferation index of less than 1%, corresponding to a grade 1 tumor (NET G1). The patient underwent right hemicolectomy, and definitive assessment of the surgical specimen confirmed the diagnosis of a grade 1 serotonin-secreting neuroendocrine tumorwith lymphnode involvement (pT3N1) [5].

  • performance of the forward viewing linear Echoendoscope for fine needle aspiration of solid and cystic lesions throughout the gastrointestinal tract a large single center experience
    Surgical Endoscopy and Other Interventional Techniques, 2014
    Co-Authors: Alberto Larghi, Fabia Attili, Domenico Galasso, Lorenzo Fuccio, Ester Diana Rossi, Matteo Napoleone, Guido Fadda, Guido Costamagna
    Abstract:

    Background A newly developed forward-viewing linear Echoendoscope (FV-EUS) has recently become available. To date, however, only scanty data on the performance of the FV-EUS scope for fine-needle aspiration (FNA) of lesions throughout the gastrointestinal (GI) tract are available. This study aimed to evaluate the technical performance of the FV-EUS scope for FNA of solid and cystic lesions located throughout the GI tract in a large cohort of patients referred to a tertiary care center.

  • fine needle tissue acquisition from subepithelial lesions using a forward viewing linear Echoendoscope
    Endoscopy, 2013
    Co-Authors: Alberto Larghi, Fabia Attili, Giuseppe Vanella, Lorenzo Fuccio, Matteo Napoleone, Gaia Chiarello, Giovanni Battista Paliani, Guido Rindi, Luigi Maria Larocca, Guido Costamagna
    Abstract:

    Background and study aims: The overall diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS – FNA) for subepithelial lesions (SELs) is suboptimal. The aim of this study was to evaluate the diagnostic accuracy, defined as the proportion of correct diagnoses, obtained using the EUS-guided fine-needle tissue acquisition (FNTA) sampling technique performed with the newly developed forward-viewing EUS scope (FV-EUS). Patients and methods: This was a retrospective analysis of a prospectively collected database including all consecutive patients with SELs who underwent EUS – FNTA using the FV-EUS scope from 2007 to 2011 in a tertiary referral center. All procedures were performed by a single expert endoscopist. Results: A total of 121 consecutive patients with SELs (13 in the esophagus, 96 in the stomach, 10 in the duodenum, 2 in the rectum) underwent sampling of the lesion using the FV-EUS scope. The procedure was technically feasible in all but one patient, and no complication related to EUS – FNTA occurred. Full histological assessment including immunostaining could be completed in 93.4 % (113 /121) of the patients. Considering neoplastic vs. non-neoplastic diseases, the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 92.8 % (95 %CI 86.3 – 96.8), 100 % (95 %CI 69.0 – 100 %), infinity, and 0.07 (95 %CI 0.04 – 0.14), respectively. Conclusions: EUS – FNTA performed in conjunction with the FV-EUS scope for sampling SELs of the gastrointestinal tract was safe and provided a very high diagnostic accuracy. Studies comparing FV-EUS with standard curved linear Echoendoscopes are needed to clarify whether these results are due to the sampling technique or the type of scope utilized.

Fabia Attili - One of the best experts on this subject based on the ideXlab platform.

  • forward viewing linear Echoendoscope a new option in the endoscopic ultrasound armamentarium with video
    Journal of Hepato-biliary-pancreatic Sciences, 2015
    Co-Authors: L Fuccio, Fabia Attili, Alberto Larghi
    Abstract:

    The forward-viewing linear Echoendoscope (FV-EUS) has been developed with the aim of overcoming limitations of standard curved linear-array Echoendoscopes (CLA-EUS) and to further expand interventional applications of EUS. The main characteristic of the FV-EUS is a shifting in the orientation of both endoscopic and ultrasound views from oblique to forward, with the exit of the working channel at the tip of the instrument. This allows exit of the devices parallel to the longitudinal axis of the endoscope, thus resulting in a more direct and stable access to the lesion while increasing the precision and force applied to the target. Accumulating evidence has shown that the FV-EUS can be used instead of the standard CLA-EUS scope for routine fine needle aspiration, with extremely good performance for subepithelial lesions and for difficult to reach locations. Several areas of use of this Echoendoscope are yet to be better defined, such as its potential for therapeutic and interventional procedures, as well as for natural orifice transluminal endoscopic surgery. The current report provides an updated overview of the available evidence for both diagnostic and interventional uses of the FV-EUS.

  • endoscopic ultrasound guided fine needle tissue acquisition from a subepithelial lesion in the distal ileum using the forward viewing Echoendoscope
    Endoscopy, 2014
    Co-Authors: Domenico Galasso, Fabia Attili, Franco Scaldaferri, Giuseppe Vanella, Frediano Inzani, Guido Costamagna, Alberto Larghi
    Abstract:

    In a context of rapidly expanding indications for endoscopic ultrasound (EUS)guided procedures, a dedicated forwardviewing linear therapeutic Echoendoscope (FV-EUS) has been developed and tested for different clinical indications [1–3]. The frontal endoscopic view combined with the exit of the working channel at the tip of the Echoendoscope offers some unique advantages over the standard curvilinear Echoendoscope. This has opened up new possibilities for EUS-guided fineneedle aspiration and tissue acquisition (EUS-FNTA) from difficult targets and combined endoscopic/EUS treatment [3, 4]. We have previously described the possibility of using FV-EUS to navigate easily through the colon to reach and sample extracolonic lesions located above the sigmoid tract [4]. We now report the first case of intubation of the ileocecal valve followed by sampling of a distal ileal lesion performed using the FV-EUS. A 68-year-old woman with a 13-year history of ulcerative colitis was found on routine surveillance colonoscopy to have a 1.5cm lesion in the terminal ileum that presented characteristics suggestive of a subepithelial lesion with a normal-appearing overlyingmucosal layer (●" Fig.1). To exclude extrinsic compression, computed tomography was carried out and confirmed the presence of a wall thickening or lesion at the level of the terminal ileum, close to the ileocecal valve. Colonoscopy using the FV-EUS was attempted and was completed up to the cecum. The terminal ileumwas then intubated and, under EUS guidance, a hypoechoic lesion measuring 14×10mm and confined to the thirdwall layer was detected. EUS-FNTAusinga 19-gaugeneedlewas performed (●" Fig.2, ●" Video1) and a tissue sample obtained (●" Fig.3), which revealed a serotonin-secreting neuroendocrine tumor with a Ki67 proliferation index of less than 1%, corresponding to a grade 1 tumor (NET G1). The patient underwent right hemicolectomy, and definitive assessment of the surgical specimen confirmed the diagnosis of a grade 1 serotonin-secreting neuroendocrine tumorwith lymphnode involvement (pT3N1) [5].

  • performance of the forward viewing linear Echoendoscope for fine needle aspiration of solid and cystic lesions throughout the gastrointestinal tract a large single center experience
    Surgical Endoscopy and Other Interventional Techniques, 2014
    Co-Authors: Alberto Larghi, Fabia Attili, Domenico Galasso, Lorenzo Fuccio, Ester Diana Rossi, Matteo Napoleone, Guido Fadda, Guido Costamagna
    Abstract:

    Background A newly developed forward-viewing linear Echoendoscope (FV-EUS) has recently become available. To date, however, only scanty data on the performance of the FV-EUS scope for fine-needle aspiration (FNA) of lesions throughout the gastrointestinal (GI) tract are available. This study aimed to evaluate the technical performance of the FV-EUS scope for FNA of solid and cystic lesions located throughout the GI tract in a large cohort of patients referred to a tertiary care center.

  • fine needle tissue acquisition from subepithelial lesions using a forward viewing linear Echoendoscope
    Endoscopy, 2013
    Co-Authors: Alberto Larghi, Fabia Attili, Giuseppe Vanella, Lorenzo Fuccio, Matteo Napoleone, Gaia Chiarello, Giovanni Battista Paliani, Guido Rindi, Luigi Maria Larocca, Guido Costamagna
    Abstract:

    Background and study aims: The overall diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS – FNA) for subepithelial lesions (SELs) is suboptimal. The aim of this study was to evaluate the diagnostic accuracy, defined as the proportion of correct diagnoses, obtained using the EUS-guided fine-needle tissue acquisition (FNTA) sampling technique performed with the newly developed forward-viewing EUS scope (FV-EUS). Patients and methods: This was a retrospective analysis of a prospectively collected database including all consecutive patients with SELs who underwent EUS – FNTA using the FV-EUS scope from 2007 to 2011 in a tertiary referral center. All procedures were performed by a single expert endoscopist. Results: A total of 121 consecutive patients with SELs (13 in the esophagus, 96 in the stomach, 10 in the duodenum, 2 in the rectum) underwent sampling of the lesion using the FV-EUS scope. The procedure was technically feasible in all but one patient, and no complication related to EUS – FNTA occurred. Full histological assessment including immunostaining could be completed in 93.4 % (113 /121) of the patients. Considering neoplastic vs. non-neoplastic diseases, the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 92.8 % (95 %CI 86.3 – 96.8), 100 % (95 %CI 69.0 – 100 %), infinity, and 0.07 (95 %CI 0.04 – 0.14), respectively. Conclusions: EUS – FNTA performed in conjunction with the FV-EUS scope for sampling SELs of the gastrointestinal tract was safe and provided a very high diagnostic accuracy. Studies comparing FV-EUS with standard curved linear Echoendoscopes are needed to clarify whether these results are due to the sampling technique or the type of scope utilized.

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