Advanced Endoscopy Fellows Program | September 2024-ASGE Tech Document

ASGE Tech Document_Devices for use with EUS 2017

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The **STATUS EVALUATION REPORT on Devices for Use with Endoscopic Ultrasound (EUS)**, prepared by the ASGE Technology Committee, examines and reviews EUS devices that have been introduced post-2007, extending beyond the primary needle-based applications for fine needle aspiration (FNA). The review uses evidence-based methodology, incorporating MEDLINE and MAUDE database searches to gather clinical data and adverse event reports relevant to these technologies.<br /><br />EUS devices are utilized predominantly with linear array echoendoscopes for accurate image-guided procedures. These devices include single-use FNA needles available in 19G, 22G, and 25G sizes made from a variety of materials to enhance echogenicity. The arrays employ various technical modifications to bolster their ultrasound visibility. This report details several FNA needles such as the Beacon EUS delivery system, Expect series, and Echotip Ultra, amongst others.<br /><br />The report also covers fine-needle biopsy (FNB) devices tailored to obtain core samples suitable for histologic examination, including the ProCore and SharkCore needles. These devices show comparable diagnostic yields to traditional FNA needles but often require fewer passes for diagnostic sufficiency.<br /><br />In addition to diagnostic aspirations and biopsies, EUS technology now encompasses a broader range of therapeutic applications and ancillary devices:<br />- **Cytology brush** for sampling epithelial lining of pancreatic cysts.<br />- **Microforceps** for histologic sampling beneath the epithelial surface.<br />- **Needle-based confocal laser endomicroscopy (nCLE)** probe for real-time, in vivo microscopy.<br />- **Radiofrequency ablation catheter** for targeted tissue cauterization.<br />- **Fiducial markers** for image-guided radiation therapy.<br />- **Lumen-apposing metal stents (e.g., AXIOS)** for drainage of fluid collections.<br /><br />Clinical outcomes, safety profiles, and financial considerations regarding these devices are evaluated extensively, pointing out the high sensitivity and specificity of EUS-FNA for pancreatic masses, variances in technique efficacy, and adverse event rates being generally low, though higher for certain invasive instruments like EchoBrush.<br /><br />Future research aims to refine EUS techniques and expand on comparative studies, optimizing both diagnostic and therapeutic outcomes in gastrointestinal endoscopy practice.<br /><br />**Summary**: The report by ASGE assesses various EUS devices, detailing their technical specifications, clinical utility, and safety, along with cost considerations, identifying the need for further research to optimize their use in clinical practice.

Keywords

Endoscopic Ultrasound

EUS devices

Fine Needle Aspiration

Fine Needle Biopsy

Therapeutic applications

Cytology brush

Microforceps

Confocal laser endomicroscopy

Radiofrequency ablation

Lumen-apposing stents