Endoscopy 2018; 50(04): S59
DOI: 10.1055/s-0038-1637201
ESGE Days 2018 oral presentations
20.04.2018 – EUS: diagnostic
Georg Thieme Verlag KG Stuttgart · New York

FIRST CLINICAL RESULTS WITH A NOVEL EUS-GUIDED THROUGH-THE-NEEDLE MICROBIOPSY FORCEPS FOR IMPROVED DIAGNOSTICS OF PANCREATIC CYSTS

B Kovacevic
1   Copenhagen University Hospital Herlev and Gentofte, Gastro Unit, Division of Endoscopy, Herlev, Denmark
,
J Gásdal Karstensen
1   Copenhagen University Hospital Herlev and Gentofte, Gastro Unit, Division of Endoscopy, Herlev, Denmark
2   Slagelse Hospital, Department of Gastrointestinal Surgery, Slagelse, Denmark
,
P Klausen
1   Copenhagen University Hospital Herlev and Gentofte, Gastro Unit, Division of Endoscopy, Herlev, Denmark
,
A Toxværd
3   Copenhagen University Hospital Herlev and Gentofte, Department of Pathology, Herlev, Denmark
,
E Kalaitzakis
1   Copenhagen University Hospital Herlev and Gentofte, Gastro Unit, Division of Endoscopy, Herlev, Denmark
,
C Vestrup Rift
4   Copenhagen University Hospital Rigshospitalet, Department of Pathology, Copenhagen, Denmark
,
JH Storkholm
5   Copenhagen University Hospital Rigshospitalet, Department of Gastrointestinal Surgery, Copenhagen, Denmark
,
C Palnæs Hansen
5   Copenhagen University Hospital Rigshospitalet, Department of Gastrointestinal Surgery, Copenhagen, Denmark
,
J Preuss Hasselby
4   Copenhagen University Hospital Rigshospitalet, Department of Pathology, Copenhagen, Denmark
,
P Vilmann
1   Copenhagen University Hospital Herlev and Gentofte, Gastro Unit, Division of Endoscopy, Herlev, Denmark
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

Pancreatic cysts represent a diagnostic dilemma as some of them may harbor malignancy or have potential for malignant transformation. Recently, a novel biopsy forceps (Moray™) has become available allowing endoscopic ultrasound (EUS) guided procurement of microbiopsy material from the cyst wall. There is at present very little experience with this device. The aim of this study was to evaluate the use of the micro-forceps in a clinical setting.

Methods:

Patients referred for EUS evaluation of a pancreatic cyst and attempted EUS-guided microbiopsy procedure were included retrospectively from one tertiary care center. After puncturing the cyst with a 19G FNA needle, the microbiopsy forceps was introduced through the needle and biopsy specimens were obtained from the cyst wall. Subsequently, the cyst fluid was aspirated and sent for tumor marker analysis and cytological evaluation. Technical success was defined as obtainment of at least one microbiopsy. Diagnostic yield was defined as the proportion of the microbiopsies where both epithelium and stroma was present.

Results:

The microbiopsy forceps was used in 31 patients. We found a technical success rate of 87.1% (n = 27). Biopsies were generally of good quality with a diagnostic yield of 71% (n = 22). EUS-FNA cytology was obtained in 58.1% of the cases. However, cytology provided specific diagnosis in only 12.9% of cases compared to 71% in case of microbiopsies (p< 0.001). Histopathological evaluation of the microbiopsies changed presumed diagnosis in 16.1%, supported presumed diagnosis in 25.8%, and contributed to further characterization of the cystic lesion in 35.5% of cases. Three adverse events were recorded (9.7%), two cases of infection and one case of mild pancreatitis.

Conclusions:

The use of the novel microbiopsy forceps seems safe with acceptable rate of technical success. Microbiopsies seem to have higher diagnostic yield compared to EUS-FNA cytology. Furthermore, obtaining EUS-guided microbiopsies seem to impact clinical decision-making.