Mo1378 Initial Experience With a Novel Endoscopic Ultrasound Guided Fine Needle Core Biopsy Device

Endoscopic ultrasound guided fine needle biopsy (EUS-FNB) provides core tissue acquisition for histologic assessment. Current trucut devices for EUS guided biopsy cannot reliably perform this technique with additional echoendoscope angulation. A novel prototype EUS FNB needle (Procore, Cook Medical) has been developed in 19 and 22 gauges with enhanced flexibility to enable tissue acquisition. To report our initial experience with this device for EUS-FNB in terms of efficacy and safety profiles. A retrospective chart review was performed of a prospectively collected IRB-approved database of all patients who underwent EUS-FNB using this needle. The needle gauge, ease of use, and its order of usage compared with a standard 19/22 gauge (EchoTip ULTRA, Cook) fine needle aspiration (FNA) were noted. Final pathology and cytology results of all samples, and complications were assessed. 20 patients (9 male, mean age 66 years) underwent EUS-FNB from April through November 2010. Target lesions included 5 pancreatic head solid masses, 2 pancreatic body masses, 2 pancreatic tail masses, 2 gastric subepithelial lesions (SEL), 1 celiac lymph node, 1 periduodenal mass, 1 common hepatic duct mass, 1 pancreatic head cystic lesion, 2 retroperitoneal masses, 1 pseudo-achalasia mass, and 2 esophageal SEL. Mean size of the target lesions was 35.4 mm (range 10-80 mm). In addition to standard 22 gauge FNA, 1 patient had 19 and 22 gauge FNB, 11 had 19 gauge FNB, and 1 had 22 gauge FNB. Two had only 19 and 22 gauge FNB, 1 had 19 gauge FNB only, and 2 had 22 gauge FNB only. Two had 19 gauge FNB and FNA. A total of 17 of the 19 gauge FNB needles and 6 of the 22 gauge FNB needles were used in this study. FNA was done in 15 patients of the same site, with 1/15 of these done prior to FNB. Final histology was confirmatory in 95% of all FNB samples to make a pathologic diagnosis with core specimens, and also in 87% of standard FNA cytology specimens. The mean number of passes performed with 19 and 22 gauge FNB needles were 1.4 and 2.3 respectively, while the mean number of passes with a standard FNA needle was 3.7. No complications occurred, however 100% of the 19 gauge stylets were difficult to remove once the needle was inserted into a target lesion. Our initial experience with this novel EUS-FNB device demonstrates promising results, with higher overall accuracy using fewer number of passes to achieve a diagnosis, and no additional complications noted. It also can obtain tissue from the periduodenal/pancreatic head region, which has been a limitation of traditional EUS guided trucut biopsy. Ongoing comparative data collection should be pursued to further delineate this device's capacity to achieve complete histologic diagnosis, and its impact on clinical management/cost and need for onsite cytopathology interpretation.