Endoscopic ultrasound-guided fine-needle aspiration from ascites and peritoneal nodules: A scoping review

Our plain-English summary of Endoscopic ultrasound-guided fine-needle aspiration from ascites and peritoneal nodules: A scoping review, by V. Sharma, S.S. Rana, S.U. Ahmed, et al (Endoscopic Ultrasound, 2017).

The study

• Authors: V. Sharma, S.S. Rana, S.U. Ahmed, S. Guleria, R. Sharma, R. Gupta
• Journal: Endoscopic Ultrasound
• Published: 2017;6(6):382-388
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The peritoneum is involved in many diseases such as primary malignancy (mesothelioma), infectious disease (tuberculosis), and disseminated malignancy (peritoneal carcinomatosis). The peritoneal disease may manifest as ascites and/or peritoneal masses or nodules. Endoscopic ultrasound (EUS), due to its ability to provide high-resolution images, has revolutionized the imaging and diagnosis of pancreaticobiliary diseases among other gastrointestinal conditions. EUS can not only help in imaging of various lesions close to the gastrointestinal lumen but also aspirate/biopsy them. We conducted a systematic search to identify published literature on the value of EUS in detection and diagnosis of peritoneal disorders. This review aims to summarize the available literature on the use of EUS-guided paracentesis and fine-needle aspiration from peritoneal nodules.

In plain English

This article was a scoping review of earlier published reports, not a new study of patients. On February 28, 2017, the authors searched PubMed for reports on endoscopic ultrasound (EUS) used from inside the stomach or duodenum to guide a needle. The needle was used either to draw abdominal fluid (ascites) or to sample nodules on the abdominal lining (peritoneum). Of 227 search results, they included 5 reports on drawing fluid for testing and 4 case series on sampling peritoneal nodules. In the reviewed reports, fluid testing sometimes missed cancer. In one series of 60 patients, 42 were classified as benign, but follow-up suggested 45 had underlying malignant disease. In one large nodule series, 21 of 32 patients judged operable on CT or MRI were reclassified as inoperable. Complications were described as infrequent. The authors concluded that EUS is an excellent tool for detecting small amounts of ascites, and that nodule sampling appears to have a good yield for diagnosing cancer spread to the peritoneum. They noted that most reports were small case series.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Scoping review of published literature found through a PubMed search
• Who was studied: Published English-language original papers and case series of at least 3 patients, from a search done February 28, 2017. The authors included 5 reports on EUS-guided paracentesis (USA 4, Japan 1) and 4 case series on FNA of peritoneal nodules (USA 2, India 1, Turkey 1).
• Exposure: No asbestos or other exposure was studied. The review concerned a diagnostic procedure: EUS-guided paracentesis (drawing ascitic fluid, mainly for cytological testing) and EUS-guided fine-needle aspiration of peritoneal nodules.
• Main results:
  • The PubMed search returned 227 results. Five paracentesis reports and four peritoneal nodule case series were included.
  • In a reviewed report of 60 patients who underwent EUS-guided paracentesis, EUS-FNA classified 42 patients as having benign ascites. Follow-up eventually suggested that 45 patients had underlying malignant disease.
  • In a reviewed series of 31 patients, 7 of those whose fluid tested negative for malignancy underwent surgery. Five of these 7 had false negative cytology.
  • In a reviewed report of 25 patients, 16 had positive peritoneal cytology. Unnecessary surgery could be avoided in 10 of these 16.
  • In one large reviewed report on EUS-FNA of peritoneal nodules, 21 of 32 patients found resectable on CT or MRI were converted to unresectable.
  • Complications across the reviewed reports were infrequent. They included fever, peritonitis and pain, one hypertensive emergency, and one case of pancreatitis in a patient who also underwent ERCP. In one report of 25 patients, one patient developed bacterial peritonitis despite periprocedural antibiotics.
• The authors' conclusion: The authors concluded that EUS is an excellent tool for detecting small amounts of ascites, and that EUS paracentesis may help diagnose peritoneal carcinomatosis in a subset of patients. They added that EUS-guided FNA of peritoneal nodules appears to have a good yield for this diagnosis, although other causes such as tuberculosis, pseudomyxoma or lymphoma are occasionally identified.
• Limitations the authors state:
  • The literature consisted mostly of a limited number of reports, most of them small case series.
  • Most included studies were retrospective, so complete follow-up diagnoses may not be available and clinical utility cannot be fully estimated.
  • The retrospective studies may have selection or inclusion bias, because only successful cases would be included.
  • The added value of finding and sampling peritoneal nodules has not been evaluated prospectively.

Topics

Medical terms in this study, explained in our Lexicon: Ultrasound, Fine-Needle Aspiration, Ascites, Peritoneum, Mesothelioma, Aspirate, Biopsy, paracentesis.

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