Download PDF
Endoscopy 2019; 51(06): 560-565
DOI: 10.1055/a-0790-8436
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for diagnosis of gastric subepithelial tumors: a pilot study

Ming-Ming Zhang
1   Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
,
Ning Zhong
1   Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
,
Xiao Wang
2   Department of Pathology, Qilu Hospital, Shandong University, Jinan, China
,
Chang-Qing Li
1   Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
,
Rui Ji
1   Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
,
Zhen Li
1   Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
,
Xiang Gu
1   Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
,
Yan-Bo Yu
1   Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
,
Li-Xiang Li
1   Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
,
Xiu-Li Zuo
1   Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
,
Yan-Qing Li
1   Department of Gastroenterology, Laboratory of Translational Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
› Author AffiliationsTRIAL REGISTRATION: single-center, prospective, pilot study NCT02936986 at clinicaltrials.gov
Further Information

Publication History

submitted 12 July 2018

accepted after revision 19 October 2018

Publication Date:
20 December 2018 (online)

Also available at
    Permissions and Reprints

Abstract

Background The diagnostic yield of current techniques for gastric subepithelial tumors (SETs) is suboptimal. This prospective study aimed to develop diagnostic criteria for needle-based confocal laser endomicroscopy (nCLE) of gastric SETs, and to evaluate the diagnostic efficacy, feasibility, and safety of endoscopic ultrasound-guided nCLE (EUS-nCLE).

Methods Eligible patients were prospectively recruited to undergo EUS-nCLE. Four unblinded investigators evaluated nCLE videos and corresponding histopathology to develop the nCLE criteria. The recorded nCLE videos were reviewed off-line by one endoscopist 3 months later. Image quality (five-point scale, 1 = poor and 5 = very good) and the interobserver agreements were assessed.

Results All 33 patients underwent successful EUS-nCLE procedures. The nCLE criteria for gastric SETs were established. Overall accuracy of off-line nCLE was significantly higher than that of EUS alone (87.9 % vs. 63.6 %; P = 0.02). The mean image quality score was 3.9. The kappa values of the interobserver agreements were 0.66 for gastrointestinal stromal tumor, 0.89 for ectopic pancreas, 0.58 for leiomyoma, and 0.72 for carcinoma.

Conclusions EUS-nCLE was feasible and safe to accurately diagnose gastric SETs.

Fig e1, Table e1, e4, e5

 

  • References

  • 1 Karaca C, Turner BG, Cizginer S. et al. Accuracy of EUS in the evaluation of small gastric subepithelial lesions. Gastrointest Endosc 2010; 71: 722-727
    CrossrefPubMedGoogle Scholar
  • 2 Akahoshi K, Sumida Y, Matsui N. et al. Preoperative diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration. World J Gastroenterol 2007; 13: 2077-2082
    CrossrefPubMedGoogle Scholar
  • 3 Philipper M, Hollerbach S, Gabbert HE. et al. Prospective comparison of endoscopic ultrasound-guided fine needle aspiration and surgical histology in upper gastrointestinal submucosal tumors. Endoscopy 2010; 42: 300-305
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 El Chafic AH, Loren D, Siddiqui A. et al. Comparison of FNA and fine-needle biopsy for EUS-guided sampling of suspected GI stromal tumors. Gastrointest Endosc 2017; 86: 510-515
    CrossrefPubMedGoogle Scholar
  • 5 Mekky MA, Yamao K, Sawaki A. et al. Diagnostic utility of EUS-guided FNA in patients with gastric submucosal tumors. Gastrointest Endosc 2010; 71: 913-919
    CrossrefPubMedGoogle Scholar
  • 6 Varadarajulu S, Fraig M, Schmulewitz N. et al. Comparison of EUS-guided 19-gauge Trucut needle biopsy with EUS-guided fine-needle aspiration. Endoscopy 2004; 36: 397-401
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Fernández-Esparrach G, Sendino O, Solé M. et al. Endoscopic ultrasound-guided fine-needle aspiration and trucut biopsy in the diagnosis of gastric stromal tumors: a randomized crossover study. Endoscopy 2010; 42: 292-299
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Kim JH, Chung JW, Ha M. et al. A feasible modified biopsy method for tissue diagnosis of gastric subepithelial tumors. World J Gastroenterol 2013; 19: 4752-4757
    CrossrefPubMedGoogle Scholar
  • 9 Lee CK, Chung IK, Lee SH. et al. Endoscopic partial resection with the unroofing technique for reliable tissue diagnosis of upper GI subepithelial tumors originating from the muscularis propria on EUS. Gastrointest Endosc 2010; 71: 188-194
    CrossrefPubMedGoogle Scholar
  • 10 Krishna SG, Brugge WR, Dewitt JM. et al. Needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cystic lesions: an international external interobserver and intraobserver study (with videos). Gastrointest Endosc 2017; 86: 644-654
    CrossrefPubMedGoogle Scholar
  • 11 Giovannini M, Caillol F, Monges G. et al. Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy in solid pancreatic masses. Endoscopy 2016; 48: 892-898
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Benias PC, D’Souza LS, Papafragkakis H. et al. Needle-based confocal endomicroscopy for evaluation of malignant lymph nodes – a feasibility study. Endoscopy 2016; 48: 923-928
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Lim TW, Choi CW, Kang DH. et al. Endoscopic ultrasound without tissue acquisition has poor accuracy for diagnosing gastric subepithelial tumors. Medicine (Baltimore) 2016; 95: e5246
    CrossrefPubMedGoogle Scholar
  • 14 Kim JI, Kim YH, Lee KH. et al. Type-specific diagnosis and evaluation of longitudinal tumor extent of borrmann type IV gastric cancer: CT versus gastroscopy. Korean J Radiol 2013; 14: 597-606
    CrossrefPubMedGoogle Scholar