Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is a widely used technique
for diagnosing various gastrointestinal lesions. Regarding the needles for EUS-TA,
the Acquire S (Boston Scientific, Marlborough, Massachusetts, USA) is a newly developed
Franseen needle with a sharp and tapered stylet that can improve puncture performance
while ensuring adequate tissue acquisition ([Fig. 1]). EUS-TA has also been reported to be useful in the diagnosis of ampullary tumors
[1]. Among these, gangliocytic paraganglioma (GP) is known as a rare submucosal tumor
that predominantly occurs in the second part of the duodenum and periampullary region
[2]. Histopathological diagnosis of GP requires evidence of three cellular components:
epithelioid cells, spindle cells, and ganglion cells [3]. Preoperative diagnosis of GP by EUS-TA is limited due to insufficient specimen
volume [4]. We report a case in which GP was preoperatively diagnosed by EUS-TA using the Acquire-S
([Video 1]).
Fig. 1 A novel Franseen needle (Acquire-S) has a sharp and tapered stylet for ease of puncture
when performing endoscopic ultrasound-guided tissue acquisition (EUS-TA). The tapered
stylet can be used in the advanced or retracted position based on the physician's
preference. Source: Boston Scientific Corporation.
Ampullary gangliocytic paraganglioma was preoperatively diagnosed by endoscopic ultrasound-guided
tissue acquisition using the Acquire S needle.Video 1
A 57-year-old woman was referred to our hospital due to epigastric pain and an ampullary
tumor. Blood tests showed a mild elevation of hepatobiliary enzymes. Contrast-enhanced
computed tomography suggested a hypervascular tumor located from the second to the
third part of the duodenum. Endoscopic findings revealed a pedunculated, non-exposed
ampullary tumor extending from the papilla to the third part of the duodenum ([Fig. 2]). As the mucosal biopsy did not yield a definitive pathological diagnosis, EUS-TA
was performed using a 22G Acquire S needle ([Fig. 3]). Despite a soft and highly mobile tumor, the tumor was successfully punctured on
the first pass. Histopathological examination confirmed the presence of the three
cellular components, leading to the preoperative diagnosis of GP ([Fig. 4]). Subsequently, a pancreaticoduodenectomy was performed, and the final diagnosis
was also GP.
Fig. 2
a Contrast-enhanced computed tomography suggested a hypervascular tumor (yellow arrowheads)
located from the second to the third part of the duodenum. b Endoscopic findings revealed a pedunculated, non-exposed ampullary tumor measuring
approximately 50 mm in diameter, extending from the papilla to the third part of the
duodenum.
Fig. 3 Ultrasonographic images of EUS-TA. a B-mode showed a large, hypoechoic tumor located from the second to the third part
of the duodenum. b Detective flow imaging showed a hypervascular tumor. c Identification of the puncture route in areas with sparse vascularization on eFLOW.
d EUS-TA was successfully performed using a 22G Acquire S needle with the slow-pull
technique.
Fig. 4 Histopathological evaluation of the EUS-TA specimens. a A large number of epithelioid cells and spindle cells can be detected (hematoxylin
and eosin (HE) staining, ×100). b Ganglion cells can be detected under high magnification (yellow arrowhead, HE staining,
×400).
To the best of our knowledge, this is the first reported case of EUS-TA using the
Acquire S. The Acquire S is useful for challenging cases in EUS-TA, such as highly
mobile lesions.
Endoscopy_UCTN_Code_TTT_1AS_2AD
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
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