岩井 知久, 木田 光広, 長谷川 力也, 金子 亨, 山内 浩史, 奥脇 興介, 宮澤 志朗, 今泉 弘, 小泉 和三郎

Tomohisa IWAI, Mitsuhiro KIDA, Rikiya HASEGAWA, Toru KANEKO, Hiroshi YAMAUCHI, Kosuke OKUWAKI, Shiro MIYAZAWA, Hiroshi IMAIZUMI, Wasaburo KOIZUMI

北里大学医学部消化器内科学

Department of Gastroenterology, Kitasato University School of Medicine

キーワード :

【Background】
With a forward-viewing echoendoscope（FV-ES）, the axis of the endoscope is aligned with the direction of puncture, in contrast to a conventional oblique-viewing echoendoscope（OV-ES）. Because imaging techniques for visualizing objects and treatment procedures with a FV-ES differ from those of an OV-ES, FV-ES is expected to play new roles in diagnosis and treatment. Subjects and Methods: We studied 111 patients（47 men and 54 women; mean age, 66.3 years; range, 22 to 86）who underwent diagnostic puncture and therapeutic procedures with the use of a prototype FV-ES（XGIF-UCT160J）and a commercially available FV-ES（TGF-UC260J）in our hospital from November 2006 through January 2016. We compared the diagnostic accuracy rates and procedural success rates between the two types of scopes. Diagnostic endoscopic ultrasound fine-needle aspiration（EUS-FNA）was performed in 85 patients: pancreatic masses in 37，submucosal tumors in 35，and others in 13（lymph nodes in 10，retroperitoneal tumor in 1，thickening of the pyloric region of the stomach in 1，and bile-duct stricture in 1）. Therapeutic endoscopic ultrasonography（EUS）was performed in 26 patients: EUS-CD in 13，EUS-BD in 9（CDS in 6，GBDS in 1，and CJS in 2）, EUS-PD in 3，and EUS-CPN in 1.
【Results】
The specimen collection rate and diagnostic accuracy rate of EUS-FNA were respectively 91.9％（34/37）and 91.9％（34/37）for pancreatic tumors. In patients with submucosal tumors, the tissue collection rate was 85.7％（30/35）, and the rate of definitive diagnosis on immunostaining was 85.7％（30/35）. In patients with tumors in other regions, the rates were 84.6％（11/13）and 85.7％（30/35）, respectively. The procedural success rate of endoscopic stent placement was 100％（13/13）for EUS-CD, 88.9％（8/9）for EUS-BD, 100％（3/3）for EUS-PD, and 100％（1/1）for EUS-CPN. The reasons for procedural non-accomplishment were stent migration in the abdominal cavity during EUS-CD in the 1 patient with WON and mispuncture of a dilated bile duct（B6）during EUS-BD（CJS）for a stricture at the choledochojejunostomy site in 1 patient. Procedural accidents were active bleeding requiring clipping hemostasis at the time of FNA in 1 patient and bile leakage requiring an additional puncture after EUS-GBDS in 1 patient.
【Conclusions】
FNA performed with an FV-ES provided good rates of specimen collection and diagnostic accuracy. FV-ES was suggested to be a useful device because procedures such as puncture, dilation, and stent placement can be reliably performed along the same axis as the scope at the time of treatment.