Introduction Oesophageal strictures/narrowing pose a distinct challenge during linear pancreatico-biliary endoscopic ultrasound (EUS) examination as the linear echoendoscope has a relatively rigid tip, large diameter and is oblique viewing. Significant oesophageal narrowing may therefore preclude linear EUS guided fine needle aspiration (FNA). The ultrasonic endobronchial videoscope (EBUS) has a much thinner diameter but, is considerably shorter and does not have air insufflation. It may however be of use in scenarios when there is oesophageal narrowing.1
Methods We report the retrospective assessment of our experience of using the EBUS scope to characterise and FNA pancreatic and mediastinal lesions that were unsuitable for EUS examination using the linear echoendoscope. Our unit performs in excess of 750 pancreaticobiliary EUS examination a year.
Results Patient 1: 76-year-old man presented with mass in body of pancreas. He had an oesophageal stricture which impeded passage of a linear echoendoscope (Pentax EG-3870UTK). The Pentax endo-bronchial videoscope EB-1970OUK (EBUS) was used, which passed the stricture easily. EUS demonstrated multiple hypoechoic lesions. Tissue elastography revealed a blue predominant pattern with elevated strain ratio suggesting malignancy. FNA confirmed metastatic renal cell carcinoma. Patient 2: 63-yr-old female presented with progressive dyspnoea, dysphagia and stridor. CT showed massive mediastinal lymphadenopathy compressing the airway (over 13 cm) and the oesophagus. The length of compression meant an airway stent was not feasible. EUS-FNA was requested to obtain tissue to assess suitability for chemo-radiotherapy. The linear echoendoscope would not pass. EBUS scope documented massive mediastinal lymphadenopathy. FNA confirmed high grade neuroendocrine/small cell carcinoma. Patient 3: A 72-year-old gentleman presented with inoperable pancreatic malignancy based on CT scan abdomen. EUS-FNA was requested prior to initiation of chemotherapy. The linear echoendoscope would not pass the narrowed gastro-oesophageal junction probably secondary to achalasia. The EBUS scope was negotiated. There was a 27 mm mass in the body of pancreas extending posteriorly and involving the portal vein confluence. FNA was successfully obtained.
Conclusion We report the successful usage of EBUS scope to examine abnormalities inaccessible to the standard linear echoendoscope. This work stresses the need to adopt new technologies to enhance the available diagnostic strategies for our patients.
Competing interests None declared.
Reference 1. Buxbaum JL, Eloubeidi MA. Transgastric endoscopic ultrasound guided fine needle aspiration in patients with esophageal narrowing using the ultrasonic bronchovideoscope. Dis Esophagus 2011;24:458–61.
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