Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated January 2017

Jean-Marc Dumonceau; Pierre H. Deprez; Christian Jenssen; Julio Iglesias-Garcia; Alberto Larghi; Geoffroy Vanbiervliet; Guruprasad P. Aithal; Paolo G. Arcidiacono; Pedro Bastos; Silvia Carrara; László Czakó; Gloria Fernández-Esparrach; Paul Fockens; Àngels Ginès; Roald F. Havre; Cesare Hassan; Peter Vilmann; Jeanin E. van Hooft; Marcin Polkowski

doi:10.1055/s-0043-109021

Endoscopy, Table of Contents

Endoscopy 2017; 49(07): 695-714
DOI: 10.1055/s-0043-109021

Guideline

Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated January 2017

Authors

Jean-Marc Dumonceau

¹Gedyt Endoscopy Center, Buenos Aires, Argentina
Pierre H. Deprez

²Cliniques universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
Christian Jenssen

³Department of Internal Medicine, Krankenhaus Märkisch Oderland Strauberg/Wriezen, Germany
Julio Iglesias-Garcia

⁴Gastroenterology Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
Alberto Larghi

⁵Digestive Endoscopy Unit, Catholic University, Rome, Italy
Geoffroy Vanbiervliet

⁶Department of Gastroenterology and Endoscopy, Hôpital Universitaire l’Archet, Nice, France
Guruprasad P. Aithal

⁷Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, United Kingdom
Paolo G. Arcidiacono

⁸Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele University, Milan, Italy
Pedro Bastos

⁹Gastroenterology Department Instituto Português de Oncologia do Porto, Porto, Portugal
Silvia Carrara

¹⁰Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Italy
László Czakó

¹¹First Department of Medicine, University of Szeged, Szeged, Hungary
Gloria Fernández-Esparrach

¹²Endoscopy Unit, Department of Gastroenterology, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Barcelona, Spain
Paul Fockens

¹³Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
Àngels Ginès

¹²Endoscopy Unit, Department of Gastroenterology, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Barcelona, Spain
Roald F. Havre

¹⁴National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Bergen, Norway
Cesare Hassan

⁵Digestive Endoscopy Unit, Catholic University, Rome, Italy
Peter Vilmann

¹⁵Department of Surgical Gastroenterology, Herlev Hospital and Gentofte, Hospital, Copenhagen University, Denmark
Jeanin E. van Hooft

¹³Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
Marcin Polkowski

¹⁶Department of Gastroenterology and Hepatology, Medical Centre for Postgraduate Education and Department of Gastroenterology, M. Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland

Abstract

MAIN RECOMMENDATIONS

For pancreatic solid lesions, ESGE recommends performing endoscopic ultrasound (EUS)-guided sampling as first-line procedure when a pathological diagnosis is required. Alternatively, percutaneous sampling may be considered in metastatic disease.

Strong recommendation, moderate quality evidence.

In the case of negative or inconclusive results and a high degree of suspicion of malignant disease, ESGE suggests re-evaluating the pathology slides, repeating EUS-guided sampling, or surgery.

Weak recommendation, low quality evidence.

In patients with chronic pancreatitis associated with a pancreatic mass, EUS-guided sampling results that do not confirm cancer should be interpreted with caution.

Strong recommendation, low quality evidence.

For pancreatic cystic lesions (PCLs), ESGE recommends EUS-guided sampling for biochemical analyses plus cytopathological examination if a precise diagnosis may change patient management, except for lesions ≤ 10 mm in diameter with no high risk stigmata. If the volume of PCL aspirate is small, it is recommended that carcinoembryonic antigen (CEA) level determination be done as the first analysis.

Strong recommendation, low quality evidence.

For esophageal cancer, ESGE suggests performing EUS-guided sampling for the assessment of regional lymph nodes (LNs) in T1 (and, depending on local treatment policy, T2) adenocarcinoma and of lesions suspicious for metastasis such as distant LNs, left liver lobe lesions, and suspected peritoneal carcinomatosis.

Weak recommendation, low quality evidence.

For lymphadenopathy of unknown origin, ESGE recommends performing EUS-guided (or alternatively endobronchial ultrasound [EBUS]-guided) sampling if the pathological result is likely to affect patient management and no superficial lymphadenopathy is easily accessible.

Strong recommendation, moderate quality evidence.

In the case of solid liver masses suspicious for metastasis, ESGE suggests performing EUS-guided sampling if the pathological result is likely to affect patient management, and (i) the lesion is poorly accessible/not detected at percutaneous imaging, or (ii) a sample obtained via the percutaneous route repeatedly yielded an inconclusive result.

Weak recommendation, low quality evidence.

Full Text

References

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