Kim Stephen, Hamerski Chris, Ghassemi Kourosh, Shah Janak, Bhat Yasser, Klapman Jason, Komanduri Sri, Keswani Rajesh N, Bidari Kiran, Wani Sachin, Watson Rabindra R, Muthusamy Venkataraman R
*Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles †California Pacific Medical Center, San Francisco, CA ‡Moffitt Cancer Center, Tampa, FL §Division of Gastroenterology and Hepatology, Feinberg School of Medicine at Northwestern University, Chicago, IL ∥Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO.
J Clin Gastroenterol. 2016 Aug;50(7):538-44. doi: 10.1097/MCG.0000000000000434.
The clinical utility of performing esophagogastroduodenoscopy (EGD) before linear endoscopic ultrasonography (L-EUS) to evaluate the luminal upper gastrointestinal (GI) tract is not well established.
The study was aimed to determine the prevalence of clinically meaningful luminal abnormalities (any luminal finding requiring further evaluation with mucosal biopsy or initiation of treatment) in patients undergoing L-EUS. The study also sought to compare the ability of the gastroscope and the linear echoendoscope in identifying these lesions.
A prospective, multicenter cohort study enrolled patients undergoing L-EUS for nonluminal indications. All patients underwent EGD followed by L-EUS by 2 different endoscopists. The second endoscopist was blinded to the results of the initial EGD. The identification of clinically meaningful luminal lesions and quality of endoscopic visualization of the upper GI tract were measured.
In the cohort of 175 patients, 52 (29.7%) patients had clinically meaningful luminal findings seen in the upper GI tract. There was no significant difference in the number of clinically meaningful lesions identified on EGD and L-EUS (25.1% vs. 22.9%, P=0.39). No significant difference was found in the miss rate of clinically meaningful lesions between the 2 modalities (EGD: 4.5% vs. EUS: 6.9%, P=0.39).
A substantial minority of patients undergoing L-EUS for nonluminal indications will have clinically meaningful luminal findings. The endoscopic evaluation of the luminal upper GI tract can be adequately achieved using the linear echoendoscope.
在进行线性内镜超声检查（L-EUS）之前先进行食管胃十二指肠镜检查（EGD）以评估上消化道（GI）管腔的临床实用性尚未得到充分证实。
本研究旨在确定接受L-EUS检查的患者中具有临床意义的管腔异常（任何需要通过黏膜活检进一步评估或开始治疗的管腔发现）的患病率。该研究还试图比较胃镜和线性超声内镜识别这些病变的能力。
一项前瞻性、多中心队列研究纳入了因非管腔适应症接受L-EUS检查的患者。所有患者均先接受EGD检查，然后由2名不同的内镜医师进行L-EUS检查。第二名内镜医师对初始EGD的结果不知情。测量具有临床意义的管腔病变的识别情况以及上消化道内镜检查的可视化质量。
在175例患者的队列中，52例（29.7%）患者在上消化道中发现了具有临床意义的管腔发现。EGD和L-EUS识别出的具有临床意义的病变数量无显著差异（25.1%对22.9%，P=0.39）。两种检查方式在具有临床意义的病变漏诊率方面无显著差异（EGD：4.5%对EUS：6.9%，P=0.39）。
因非管腔适应症接受L-EUS检查的患者中有相当一部分会有具有临床意义的管腔发现。使用线性超声内镜可以充分实现对上消化道管腔的内镜评估。
