Initial evaluation of the forward-viewing echoendoscope prototype for performing fine-needle aspiration, Tru-cut biopsy, and celiac plexus neurolysis.

Background And Aims: A forward-viewing echoendoscope (FV-CLA) has been recently developed for performing interventional endoscopic ultrasound (EUS). The role of FV-CLA in performing standard EUS-guided fine-needle aspiration (FNA), Tru-cut biopsy (TCB), and celiac plexus neurolysis (CPN) is unknown. Our aims were to evaluate the feasibility of the FV-CLA for performing EUS-guided FNA/TCB and CPN.

Methods: In this prospective study conducted over a 3-month period, 30 patients were evaluated with the FV-CLA. Procedures performed were FNA in 28 lesions, TCB in one, and CPN in five patients.

Results: EUS-guided FNA was undertaken at the following sites: mediastinum (n=3), liver (n=2), retroperitoneal mass (n=2), pancreas head/uncinate (n=9), pancreas body (n=6), pancreas tail (n=4), and perigastric lymph node (n=2). The median size of the lesions was 37×34 mm. A median of two passes was performed (range: 1-7). Final cytopathology diagnosed malignancies in 21 patients, with adenocarcinoma suspected for one.TCB of a mediastinal lymph node revealed lymphoma. FNA was benign in six patients. The sensitivity, specificity, positive predictive value, and negative predictive value for a malignancy diagnosis was 96% (95% confidence interval [CI], 87-96%), 100% (95% CI, 70-100%), 100% (92-100), and 86% (60-86%), respectively. CPN was successful in all five patients. It was easier to deploy the needle from the echoendoscope at all locations, including the duodenum, and irrespective of the site of the lesion.

Conclusions: The initial evaluation and safety profile of the FV-CLA echoendoscope for performing standard FNA/TCB and CPN appear to be favorable. The narrow image does not preclude basic therapeutic maneuvers. A major advantage appears to be easy needle deployment at any site within reach of the echoendoscope.