EUS in patients with surgically altered upper GI anatomy.

Area of Science:

• Gastroenterology
• Surgical Oncology
• Diagnostic Imaging

Background:

• Limited data exists on the safety and feasibility of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) in patients with surgically altered anatomy.
• Surgical alterations can pose unique challenges for standard EUS procedures.

Purpose of the Study:

• To evaluate the outcomes of EUS procedures in patients who have undergone various types of abdominal surgeries.
• To assess the safety and efficacy of EUS-guided FNA in diverse surgically modified gastrointestinal anatomies.

Main Methods:

• A retrospective study was conducted at a single tertiary-care center.
• 188 EUS procedures were performed on patients with surgically altered anatomy between July 1995 and October 2008.
• Data collected included surgical history, EUS indications, imaging limitations, FNA results, and complications.

Main Results:

• EUS and FNA were generally successful across various surgical alterations, including Billroth I/II, Whipple, Puestow, and Nissen fundoplication procedures.
• Imaging limitations were noted in some Billroth II and Roux-en-Y cases, particularly for visualizing the common bile duct and head of the pancreas.
• No significant adverse events were reported, indicating a low complication rate (0% to 1.9%).

Conclusions:

• EUS-guided FNA is a generally safe and successful procedure for patients with surgically altered anatomy in a tertiary care setting.
• While challenges exist in visualizing specific structures (e.g., pancreas, CBD) after certain surgeries like Roux-en-Y, EUS remains a valuable diagnostic tool.
• Successful pancreaticobiliary examination, including FNA, is achievable after Billroth II surgery when the afferent limb is intubated.