Endoscopy 2017; 49(07): 695-714
DOI: 10.1055/s-0043-109021
Guideline
© Georg Thieme Verlag KG Stuttgart · New York

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 Dumonceau1, Pierre H. Deprez2, Christian Jenssen3, Julio Iglesias-Garcia4, Alberto Larghi5, Geoffroy Vanbiervliet6, Guruprasad P. Aithal7, Paolo G. Arcidiacono8, Pedro Bastos9, Silvia Carrara10, László Czakó11, Gloria Fernández-Esparrach12, Paul Fockens13, Àngels Ginès12, Roald F. Havre14, Cesare Hassan5, Peter Vilmann15, Jeanin E. van Hooft13, Marcin Polkowski16
  • 1Gedyt Endoscopy Center, Buenos Aires, Argentina
  • 2Cliniques universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
  • 3Department of Internal Medicine, Krankenhaus Märkisch Oderland Strauberg/Wriezen, Germany
  • 4Gastroenterology Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
  • 5Digestive Endoscopy Unit, Catholic University, Rome, Italy
  • 6Department of Gastroenterology and Endoscopy, Hôpital Universitaire l’Archet, Nice, France
  • 7Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, United Kingdom
  • 8Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele University, Milan, Italy
  • 9Gastroenterology Department Instituto Português de Oncologia do Porto, Porto, Portugal
  • 10Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Italy
  • 11First Department of Medicine, University of Szeged, Szeged, Hungary
  • 12Endoscopy Unit, Department of Gastroenterology, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Barcelona, Spain
  • 13Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
  • 14National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Bergen, Norway
  • 15Department of Surgical Gastroenterology, Herlev Hospital and Gentofte, Hospital, Copenhagen University, Denmark
  • 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
Further Information

Publication History

submitted 02 February 2017

accepted after revision 09 February 2017

Publication Date:
16 May 2017 (eFirst)

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.