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

TY - JOUR

T1 - Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology

T2 - European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline - Updated January 2017

AU - Dumonceau, Jean-Marc

AU - Deprez, Pierre H

AU - Jenssen, Christian

AU - Iglesias-Garcia, Julio

AU - Larghi, Alberto

AU - Vanbiervliet, Geoffroy

AU - Aithal, Guruprasad P

AU - Arcidiacono, Paolo G

AU - Bastos, Pedro

AU - Carrara, Silvia

AU - Czakó, László

AU - Fernández-Esparrach, Gloria

AU - Fockens, Paul

AU - Ginès, Àngels

AU - Havre, Roald F

AU - Hassan, Cesare

AU - Vilmann, Peter

AU - van Hooft, Jeanin E

AU - Polkowski, Marcin

N1 - © Georg Thieme Verlag KG Stuttgart · New York.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - 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≤10mm 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.

AB - 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≤10mm 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.

KW - Abdomen

KW - Digestive System Neoplasms/diagnostic imaging

KW - Endosonography

KW - Gastroenterology/standards

KW - Humans

KW - Image-Guided Biopsy/standards

KW - Lymphadenopathy/diagnostic imaging

KW - Mediastinum

KW - Pancreatic Cyst/diagnostic imaging

U2 - 10.1055/s-0043-109021

DO - 10.1055/s-0043-109021

M3 - Journal article

C2 - 28511234

SN - 0013-726X

VL - 49

SP - 695

EP - 714

JO - Endoscopy

JF - Endoscopy

IS - 7

ER -