Sercan YÜKSEL, Uğur TOPAL, Mert UZUNKULAOĞLU, Şener ŞİMŞEK, Emrah AKIN, Erdal KARAKÖSE, Hasan BEKTAŞ

3.Basamak Merkez Genel Cerrahi Endoskopi Ünitesi Endoskopik Ultrasonografi Deneyimleri

Amaç: Endoskopik ultrasonografi (EUS) gastrointestinal sistem ve çevresindeki organlardaki patolojilerin tanı konulmasında kullanılır. Çalışmamızda 3. Basamak ileri merkez genel cerrahi endoskopi ünitesinin EUS ve biyopsi deneyimleri ve sonuçları literatür eşliğinde paylaşılması amaçlanmıştır. Gereç ve Yöntemler: Ocak 2021 ve Ocak 2022 tarihleri arasında genel cerrahi endoskopi ünitesinde EUS görüntülemesi yapılan hastalar retrospektif olarak incelendi. Hastaların demografik özellikleri, EUS biyopsi endikasyonları, klinik ön tanıları, preop görüntüleme yöntemleri., biyopsi sayıları ve sonuçları komplikasyon durumları analiz edildi. Bulgular: 292 hastanın ortalama yaşı 56.5 ve erkek cinsiyet %53.8 idi. En sık EUS endikasyonu pankreasta kitle %62 idi. 127 (43.4) hastaya endoskopik ince iğne aspirasyon biyopsisi yapıldı vebiyopsi yapılan kitlelerin ortalama çapı 35.1 mm idi. Biyopsi yapılan hastaların %58.2’sinde malignite saptandı. Biyopsi ve lezyon özelliklerine göre hastalarda %49.3 takip, %27.4 cerrahi, %15.4 onkolojik tedavi ve %7.9 endoskoik retrograd kolanjiopankreatografi kararı verildi. Sonuç: EUS'nin gastrointestinal malignite, pankreas hastalıkları ve biliyer hastalıkların tanı ve tedavisindeki rolü gelişmeye devam etmektedir. EUS’nin, karmaşık cerrahi ve onkoloji hastalarının ve pankreatobiliyer bozuklukları olan hastların multidisipliner yönetiminde kilit bir rol oynadığını düşünmekteyiz.

Anahtar Kelimeler:

Endoskopik ultrasonografi, ince iğne aspirasyon biyopsisi, pankreas tümörü, gastrointestinal kitle, biliyer tıkanıklık

Experiences in endoscopic ultrasonography at a tertiary center general surgery endoscopy unit

Aim: Endoscopic ultrasonography (EUS) is used for diagnosing pathologies in the gastrointestinal system and surrounding organs. This study aims to share the experiences and results of EUS and biopsy at a tertiary center general surgery endoscopy unit, in the context of the literature. Methods: Patients who underwent EUS imaging at the general surgery endoscopy unit between January 2021 and January 2022 were retrospectively reviewed. Demographic characteristics, EUS biopsy indications, clinical pre-diagnoses, preoperative imaging methods, biopsy counts, and results, as well as complications, were analyzed. Results: The mean age of the 292 patients was 56.5 years, with 53.8% being male. The most common EUS indication was a mass in the pancreas, accounting for 62%. Endoscopic fine-needle aspiration biopsy was performed on 127 (43.4%) patients, and the mean diameter of biopsied masses was 35.1 mm. Malignancy was detected in 58.2% of the biopsied patients. Based on biopsy and lesion characteristics, 49.3% of patients were followed up, 27.4% underwent surgery, 15.4% received oncological treatment, and 7.9% were given endoscopic retrograde cholangiopancreatography. Conclusion: The role of EUS in the diagnosis and treatment of gastrointestinal malignancies, pancreatic diseases, and biliary diseases continues to evolve. We believe that EUS plays a key role in the multidisciplinary management of complex surgical and oncology patients and those with pancreatobiliary disorders.

Keywords:

Endoscopic ultrasonography, fine needle aspiration biopsy, pancreatic tumor, gastrointestinal mass, biliary obstruction,

PDF

___

1.Sooklal S, Chahal P. Endoscopic Ultrasound. Surg Clin North Am. 2020; 100(6): 1133-50. https://doi.org/10.1016/j.suc.2020.07.003
2.Siddiqui UD, Levy MJ. EUS-Guided Transluminal Interventions. Gastro-enterology. 2018; 154(7): 1911-24. https://doi.org/10.1053/j.gastro.2017.12.046
3.Vilmann P, Jacobsen GK, Henriksen FW, et al. Endoscopic ultrasonogra-phy with guided fine needle aspiration biopsy in pancreatic disease. Gas-trointest Endosc. 1992; 38(2): 172-3. https://doi.org/10.1016/S0016-5107(92)70385-X
4.Dumonceau JM, Polkowski M, Larghi A, et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gas-troenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2011; 43(10): 897-912. https://doi.org/10.1055/s-0030-1256754
5.Pouw RE, Barret M, Biermann K, et al. Endoscopic tissue sampling - Part 1: Upper gastrointestinal and hepatopancreatobiliary tracts. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2021; 53(11): 1174-88. https://doi.org/10.1055/a-1611-5091
6.Iglesias-Garcia J, Lariño-Noia J, de la Iglesia-García D, et al. Endoscopic ultrasonography: Enhancing diagnostic accuracy. Best Pract Res Clin Gas¬troenterol. 2022; 60-61: 101808. https://doi.org/10.1016/j.bpg.2022.101808
7.Shah SL, Perez-Miranda M, Kahaleh M, et al. Updates in Therapeutic En-doscopic Ultrasonography. J Clin Gastroenterol. 2018; 52(9): 765-72. https://doi.org/10.1097/MCG.0000000000001104
8.Jenssen C, Alvarez-Sánchez MV, Napoléon B, et al. Diagnostic endoscopic ultrasonography: assessment of safety and prevention of complications. World J Gastroenterol. 2012; 18(34): 4659-76. https://doi.org/10.3748/wjg.v18.i34.4659
9.Dhir V, Isayama H, Itoi T, et al. Endoscopic ultrasonography-guided bili¬ary and pancreatic duct interventions. Dig Endosc. 2017; 29(4): 472-85. https://doi.org/10.1111/den.12818
10.El Hajj II, LeBlanc JK, Sherman S, et al. Endoscopic ultrasound-guided biopsy of pancreatic metastases: a large single-center experience. Pancre¬as. 2013; 42(3): 524-30. https://doi.org/10.1097/MPA.0b013e31826b3acf
11.Aydin A, Tekin F, Günşar F, et al. Value of endoscopic ultrasonography for upper gastrointestinal stromal tumors: a single center experience. Turk J Gastroenterol. 2004; 15(4): 233-7.