Utility of a repeated EUS at a tertiary-referral center

John DeWitt, Kathleen McGreevy, Stuart Sherman, Julia LeBlanc

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Background: The utility of a repeated EUS by experts is not known. Objective: To define the utility of a repeated EUS for the same indication. Design: A retrospective case series. Setting: Tertiary-referral hospital in Indianapolis, Indiana. Patients: Consecutive subjects, with and without cancer, who, between January 2000 and September 2006, underwent an initial EUS elsewhere within 6 and 12 weeks of a repeated EUS at our hospital. Interventions: A repeated EUS. Main Outcome Measurements: Clinical impact of a repeated EUS. Results: Of 8936 EUS examinations, 73 repeated procedures (0.8%) were identified, and 24 were excluded. The 49 initial EUS procedures (26 men, median age 59 years) were done in Indiana (n = 44) or another state (n = 5) by one of 15 physicians in private practice (n = 48) or at a teaching hospital (n = 1). An EUS-guided FNA (EUS-FNA) was performed during an initial EUS in 21 patients (no biopsy diagnostic for cancer) and was not attempted in 14 patients. The principle indication for a repeated EUS (n = 35) was for an EUS-FNA after the initial tissue sampling was benign, nondiagnostic, or not done. A second EUS had no clinical impact in 18 patients (37%). In the remaining 31 patients (63%), a repeated EUS provided a new or changed clinical diagnosis (n = 12), the initial diagnosis of primary pancreatic cancer (n = 5) or GI stromal tumor (GIST) (n = 1) after a previous nondiagnostic biopsy; or the initial diagnosis of primary (n = 4) or metastatic (n = 2) pancreatic cancer, metastatic esophageal cancer (n = 1), hilar cholangiocarcinoma (n = 1), GIST (n = 1), or pancreatic neuroendocrine tumor (n = 1), or an initial aspiration of a pancreatic cyst (n = 3) after a previous EUS-FNA was not able to be performed. Limitations: A retrospective design; a small number of nonpancreatic indications. Conclusions: In this study, a repeated EUS at a tertiary-referral center had a clinical impact in 63% of patients when performed by experts for a similar clinical indication.

Original languageEnglish
Pages (from-to)610-619
Number of pages10
JournalGastrointestinal Endoscopy
Volume67
Issue number4
DOIs
StatePublished - Apr 2008

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Tertiary Care Centers
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Pancreatic Neoplasms
Neoplasms
Klatskin Tumor
Pancreatic Cyst
Biopsy
Neuroendocrine Tumors
Private Practice
Esophageal Neoplasms
Teaching Hospitals
Physicians

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Utility of a repeated EUS at a tertiary-referral center. / DeWitt, John; McGreevy, Kathleen; Sherman, Stuart; LeBlanc, Julia.

In: Gastrointestinal Endoscopy, Vol. 67, No. 4, 04.2008, p. 610-619.

Research output: Contribution to journalArticle

DeWitt, John ; McGreevy, Kathleen ; Sherman, Stuart ; LeBlanc, Julia. / Utility of a repeated EUS at a tertiary-referral center. In: Gastrointestinal Endoscopy. 2008 ; Vol. 67, No. 4. pp. 610-619.
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abstract = "Background: The utility of a repeated EUS by experts is not known. Objective: To define the utility of a repeated EUS for the same indication. Design: A retrospective case series. Setting: Tertiary-referral hospital in Indianapolis, Indiana. Patients: Consecutive subjects, with and without cancer, who, between January 2000 and September 2006, underwent an initial EUS elsewhere within 6 and 12 weeks of a repeated EUS at our hospital. Interventions: A repeated EUS. Main Outcome Measurements: Clinical impact of a repeated EUS. Results: Of 8936 EUS examinations, 73 repeated procedures (0.8{\%}) were identified, and 24 were excluded. The 49 initial EUS procedures (26 men, median age 59 years) were done in Indiana (n = 44) or another state (n = 5) by one of 15 physicians in private practice (n = 48) or at a teaching hospital (n = 1). An EUS-guided FNA (EUS-FNA) was performed during an initial EUS in 21 patients (no biopsy diagnostic for cancer) and was not attempted in 14 patients. The principle indication for a repeated EUS (n = 35) was for an EUS-FNA after the initial tissue sampling was benign, nondiagnostic, or not done. A second EUS had no clinical impact in 18 patients (37{\%}). In the remaining 31 patients (63{\%}), a repeated EUS provided a new or changed clinical diagnosis (n = 12), the initial diagnosis of primary pancreatic cancer (n = 5) or GI stromal tumor (GIST) (n = 1) after a previous nondiagnostic biopsy; or the initial diagnosis of primary (n = 4) or metastatic (n = 2) pancreatic cancer, metastatic esophageal cancer (n = 1), hilar cholangiocarcinoma (n = 1), GIST (n = 1), or pancreatic neuroendocrine tumor (n = 1), or an initial aspiration of a pancreatic cyst (n = 3) after a previous EUS-FNA was not able to be performed. Limitations: A retrospective design; a small number of nonpancreatic indications. Conclusions: In this study, a repeated EUS at a tertiary-referral center had a clinical impact in 63{\%} of patients when performed by experts for a similar clinical indication.",
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