Brief Article
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World J Gastrointest Endosc. Feb 16, 2014; 6(2): 55-59
Published online Feb 16, 2014. doi: 10.4253/wjge.v6.i2.55
An automated spring-loaded needle for endoscopic ultrasound-guided abdominal paracentesis in cancer patients
Rei Suzuki, Atsushi Irisawa, Manoop S Bhutani, Takuto Hikichi, Tadayuki Takagi, Goro Shibukawa, Ai Sato, Masaki Sato, Tsunehiko Ikeda, Ko Watanabe, Jun Nakamura, Srinadh Annangi, Kazuhiro Tasaki, Katsutoshi Obara, Hiromasa Ohira
Rei Suzuki, Tadayuki Takagi, Ai Sato, Masaki Sato, Tsunehiko Ikeda, Ko Watanabe, Jun Nakamura, Hiromasa Ohira, Department of Gastroenterology and Rheumatology, Division of Medicine, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan
Atsushi Irisawa, Goro Shibukawa, Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu 969-3492, Japan
Manoop S Bhutani, Srinadh Annangi, Department of Gastroenterology, Hepatology and Nutrition, the University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Takuto Hikichi, Katsutoshi Obara, Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 960-1247, Japan
Kazuhiro Tasaki, Department of Pathology, Fukushima Medical University Hospital, Fukushima 960-1247, Japan
Author contributions: Suzuki R and Irisawa A designed the research; Suzuki R, Irisawa A, Hikichi T, Takagi T, Shibukawa G, Sato A, Sato M, Ikeda T, Watanabe K, Nakamura J and Tasaki K performed the research; Suzuki R, Irisawa A, Bhutani MS and Annangi S drafted the manuscript; Bhutani MS, Hikichi T, Obara K and Ohira H revised it critically for important intellectual content; Suzuki R, Irisawa A, Bhutani MS, Hikichi T, Takagi T, Shibukawa G, Sato A, Sato M, Ikeda T, Watanabe K, Nakamura J, Annangi S, Tasaki K, Obara K and Ohira H approved the final version to be published.
Correspondence to: Atsushi Irisawa, MD, PhD, Professor, Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Yazawa, Aizuwakamatsu 969-3492, Japan. irisawa@fmu.ac.jp
Telephone: +81-242-752100 Fax: +81-242-752568
Received: July 30, 2013
Revised: December 18, 2013
Accepted: January 7, 2014
Published online: February 16, 2014
Abstract

AIM: To evaluate the feasibility of using an automated spring-loaded needle device for endoscopic ultrasound (EUS)-guided abdominal paracentesis (EUS-P) to see if this would make it easier to puncture the mobile and lax gastric wall for EUS-P.

METHODS: The EUS database and electronic medical records at Fukushima Medical University Hospital were searched from January 2001 to April 2011. Patients with a history of cancer and who underwent EUS-P using an automated spring-loaded needle device with a 22-gauge puncture needle were included. The needle was passed through the instrument channel and advanced through the gastrointestinal wall under EUS guidance into the echo-free space in the abdominal cavity and ascitic fluid was collected. The confirmed diagnosis of malignant ascites included positive cytology and results from careful clinical observation for at least 6 mo in patients with negative cytology. The technical success rate, cytology results and complications were evaluated.

RESULTS: We found 11 patients who underwent EUS-P with an automated spring-loaded needle device. In 4 cases, ascites was revealed only with EUS but not in other imaging modalities. EUS-P was done in 7 other cases because there was minimal ascitic fluid and no safe window for percutaneous abdominal aspiration. Ascitic fluid was obtained in all cases by EUS-P. The average amount aspirated was 14.1 mL (range 0.5-38 mL) and that was sent for cytological exam. The etiology of ascitic fluid was benign in 5 patients and malignant in 6. In all cases, ascitic fluid was obtained with the first needle pass. No procedure-related adverse effects occurred.

CONCLUSION: EUS-P with an automated spring-loaded needle device is a feasible and safe method for ascites evaluation.

Keywords: Ascetic fluid, Malignancy, Endoscopic ultrasound, Paracentesis, Fine needle aspiration

Core tip: Even in patients with a minute amount of ascitic fluid, an automated spring-loaded needle device enabled us to perform endoscopic ultrasound (EUS)-guided abdominal paracentesis (EUS-P) readily, which has the potential to play an important role for staging of cancer since the establishment of malignant ascites denotes a more advanced stage of cancer.