Feasibility and Accuracy of Transduodenal Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Solid Lesions Using a 19-Gauge Flexible Needle: A Multicenter Study

Background/Aims@#Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the go-to method for obtaining samples from gastrointestinal tract and pancreatic lesions. When the transduodenal approach is utilized, the use of a more flexible needle, such as a nitinol 19-gauge (G) needle, has been recommended. The aim of this study was to evaluate the feasibility and accuracy of 19-G flexible aspiration needles in obtaining samples from solid lesions through a transduodenal approach. @*Methods@#This was a retrospective analysis of prospectively collected data from eight Italian endoscopy centers. Consecutive patients with solid lesions who underwent transduodenal EUS-FNA with a 19-G flexible needle were included. @*Results@#A total of 201 patients were enrolled. According to histology, EUS, radiology and 12 months of follow-up, 151 patients had malignant lesions and 50 patients had benign lesions. EUS-FNA was feasible in all cases. An adequate histologic sample was obtained in all except eight cases (96.1%). The sensitivity of EUS-FNA was 92.1% (95% confidence interval [CI], 86.8%–95.7%), and the specificity was 100% (95% CI, 90.5%–100%). The positive predictive value was 100% (95% CI, 93.4%–100%), and the negative predictive value was 74% (95% CI, 62.8%–82.7%). The diagnostic accuracy was 93.5% (95% CI, 89.2%–96.5%). @*Conclusions@#The transduodenal approach for obtaining samples from solid lesions using a 19-G flexible needle seems feasible and accurate.

Feasibility and Accuracy of Transduodenal Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Solid Lesions Using a 19-Gauge Flexible Needle: A Multicenter Study

Background/Aims@#Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the go-to method for obtaining samples from gastrointestinal tract and pancreatic lesions. When the transduodenal approach is utilized, the use of a more flexible needle, such as a nitinol 19-gauge (G) needle, has been recommended. The aim of this study was to evaluate the feasibility and accuracy of 19-G flexible aspiration needles in obtaining samples from solid lesions through a transduodenal approach. @*Methods@#This was a retrospective analysis of prospectively collected data from eight Italian endoscopy centers. Consecutive patients with solid lesions who underwent transduodenal EUS-FNA with a 19-G flexible needle were included. @*Results@#A total of 201 patients were enrolled. According to histology, EUS, radiology and 12 months of follow-up, 151 patients had malignant lesions and 50 patients had benign lesions. EUS-FNA was feasible in all cases. An adequate histologic sample was obtained in all except eight cases (96.1%). The sensitivity of EUS-FNA was 92.1% (95% confidence interval [CI], 86.8%–95.7%), and the specificity was 100% (95% CI, 90.5%–100%). The positive predictive value was 100% (95% CI, 93.4%–100%), and the negative predictive value was 74% (95% CI, 62.8%–82.7%). The diagnostic accuracy was 93.5% (95% CI, 89.2%–96.5%). @*Conclusions@#The transduodenal approach for obtaining samples from solid lesions using a 19-G flexible needle seems feasible and accurate.

Colonic Postpolypectomy Bleeding Is Related to Polyp Size and Heparin Use

BACKGROUND/AIMS: We studied factors influencing colon postpolypectomy bleeding (PPB), with a focus on antithrombotic and anticoagulation therapy. METHODS: We conducted a retrospective case-control study of all patients who underwent polypectomy at our tertiary referral center in Italy between 2007 and 2014. Polyp characteristics (number of polyps removed per patient, size, morphology, location, resection technique, prophylactic hemostasis methods) and patient characteristics (age, sex, comorbidities, medication) were analyzed. RESULTS: The case and control groups included 118 and 539 patients, respectively. The two groups differed in the frequency of comorbidities (69% vs. 40%, p=0.001), polyps removed (27% vs. 18%, p=0.02), and use of heparin therapy (23% vs. 1%, p<0.001). A total of 279 polyps in the case group and 966 in the control group were nonpedunculated (69% vs. 81%, p=0.01) and measured ≥10 mm (78% vs. 32%, p=0.001). Multivariate analysis showed that polyps ≥10 mm (odds ratio [OR], 6.1; 95% confidence interval [CI], 2.3–15.5), administration of heparin (OR, 16.5; 95% CI, 6.2–44), comorbidity (OR, 2.3; 95% CI, 1.4–3.9), and presence of ≥2 risk factors (OR, 3.2; 95% CI, 1.7–6.0) were associated with PPB. CONCLUSIONS: The incidence of PPB increases with polyp size ≥10 mm, heparin use, comorbidity, and presence of ≥2 risk factors.

Screening for Barrett's oesophagus with oesophageal capsule endoscopy in first-degree relatives of patients affected by Barrett's oesophagus: results of a pilot study

Barrett's oesophagus [BE] is one of the complications of gastro-oesophageal reflux disease [GERD]. Oesophageal capsule endoscopy [ECE] has been proposed as a non-invasive investigation of oesophageal pathology. The aims were to evaluate the diagnostic yield of ECE in first-degree relatives of patients with BE and reflux symptoms and to assess prospectively the prevalence of BE in these conditions. Inclusion criteria were familial history of at least one first-degree relative with BE and typical reflux syndrome. Patients underwent ECE followed by oesophagogastroduodenoscopy [EGD]. The ECE findings were compared with those during EGD. Results: Between February and October 2009, 18 patients were enrolled. Oesophagitis and endoscopically suspected oesophageal metaplasia [ESEM] were present, at ECE, in 7 and 11 patients, respectively. Intestinal metaplasia was histologically confirmed in eight patients. Sensitivity and specificity of ECE were, respectively, 86% and 91%, for oesophagitis, and 100% and 70% for ESEM; positive predictive value [PPV] and negative predictive value [NPV] were 86% and 91%, respectively, for oesophagitis and 73%and 100%, respectively, for ESEM. Prevalence of BE was 44%. ECE showed an optimal NPV for BE detection. Pending confirmation of these results, ECE could be proposed as a screening test in symptomatic relatives of patients with BE