EUS-guided FNA biopsy of the muscularis propria of the antrum in patients with gastroparesis is feasible and safe

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• 作者：Mohamed O. Othman ; MBBCh¹ ; ; Brian Davis ; MD² ; Irene Saroseik ; MD³ ; Alireza Torabi ; MD ; PhD⁴ ; Richard W. McCallum ; MD³
• 关键词：EUS-FNA ; EUS-guided FNA ; H&E ; hematoxylin and eosin ; HPFs ; high power fields ; ICC ; interstitial cells of Cajal ; IRB ; institutional review board
• 刊名：Gastrointestinal Endoscopy
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：83
• 期：2
• 页码：327-333
• 全文大小：1638 K

文摘

EUS-guided FNA biopsies of the muscularis propria of the gastric wall in patients with gastroparesis could replace the routine use of surgical full-thickness biopsies for assessing the loss of the interstitial cells of Cajal (ICCs) and cellular infiltrates in the myenteric plexus. We investigated the efficacy and safety of EUS-guided FNA biopsies of the muscularis propria of the gastric antrum in gastroparesis and compared the tissue with a surgically obtained full-thickness biopsy specimen in the same patient.

Methods

This was a prospective, nonrandomized, feasibility trial. Patients with gastroparesis who were undergoing gastric neurostimulator placement were enrolled. Patients had a gastric wall measurement by radial EUS in the body and antrum of the stomach followed by linear EUS examination and FNA of the muscularis propria in the antrum by using a 19-gauge core needle. Within 24 hours, a full-thickness biopsy specimen of the antrum was obtained surgically during neurostimulator placement. Endoscopic and surgical specimens were compared for tissue morphology, number of ICCs (c-kit stain) and enteric neurons (S-100 stain), and fibrosis (trichome) for each patient. The correlation coefficient of the ICC count per high-power field was used to compare both specimens. Continuous data were compared by using a t test.

Results

Eleven patients (10 female, 1 male), with a mean age of 40.6 years, were enrolled in the trial. EUS-guided core biopsies were successful in obtaining sufficient tissue for the histologic assessment of ICCs in 9 patients (81%) and for the myenteric plexus in 6 patients (54%). There was a good correlation coefficient (0.65) when both surgical and endoscopic groups were compared for the loss of ICCs. Mild serosal bruising and/or localized hematoma formations were noted at the sites of EUS biopsies, but there were no serosal tears, perforations, or adverse effects on the hospitalization and outcomes.

Conclusions

EUS-guided FNA of the gastric muscularis propria in patients with gastroparesis is safe and provides adequate tissue for full histologic assessment. (Clinical trial registration number: NCT01916460.)