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Background: The aim of therapy for advanced esophageal cancer is relief of dysphagia with minimal treatment-related morbidity. This study assessed the efficacy of endoscopic intratumoral injection of cisplatin/epinephrine gel to relieve obstruction and improve swallowing. The gel is designed to minimize diffusion of active drug away from the tumor injection site. Methods: Patients with inoperable esophageal cancer and dysphagia caused by exophytic esophageal tumor underwent up to 6 weekly endoscopic injections of the gel. Response was documented objectively (exophytic tumor volume, lumen size, dysphagia grade) and subjectively (achievement of treatment goal). Results: Twenty-four patients were treated. Primary evaluation criteria for 18 evaluable patients were as follows: dysphagia grade improved in 4 (duration 30 to 45 days) and stabilized in 11; lumen patency improved in 6 (duration 29 to 56 days) and stabilized in 10; exophytic tumor volume decreased in 8 (duration 29 to 114 days). Eight patients felt that their ability to swallow improved. One patient with intramural and exophytic tumor developed a tracheoesophageal fistula, possibly related to treatment. Other complications were tolerable and self-limited. No nephrotoxicty or severe nausea/vomiting typical of systemic administration of cisplatin occurred. Conclusions: Endoscopic injection of cisplatin/epinephrine gel is a straightforward procedure with standard equipment and techniques, which can provide palliation for patients with exophytic malignant tumors of the esophagus. Assessment of this method in conjunction with other therapeutic options such as brachytherapy is warranted. (Gastrointest Endosc 2002;56:644-51.)

Tu1649 Comparison of EUS-Guided Tissue Acquisition Using 25-Gauge and 22-Gauge Core Biopsy Needles Through Needle Cross-Over: a Prospective, Randomized Study Se Woo Park*, Moon Jae Chung, Jeong Youp Park, Seung Woo Park, SI Young Song, Seungmin Bang Department of Internal Medicine, Institute of Gastroenterology, Hallym University College of Medicine, Hallym University Dongtan Sacred Heart Hospital, Gyeonggi-do, Korea (the Republic of); Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (the Republic of) Backgrounds: Even though theoretically thicker needle is able to get more tissue, hardness of the needle can lead to mechanical damage to endoscope, technical failure or potential blood contamination of sample. It is uncertain if needle gauge impacts the diagnostic outcomes of endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) of pancreatic mass lesions. Aim The aim of this study was to evaluate 25G core biopsy needles in procurement rate of histologic core compared with 22G needles through EUS-FNB of pancreatic mass. Methods: From March 2014 to July 2014, 56 patients with solid pancreatic mass underwent EUS-FNB with both 25G and 22G core biopsy needle. Needle sequence was selected randomly, and two passes were made with each needle, consisting of 20 uniform to-and-fro movements on each pass with 10-ml syringe suction. A pathologist blinded to sequence of needle evaluated specimens for presence of the histologic core. Results: The mean age of the patients was 65.8 9.5 (range, 44-89) and 35 patients (62.5%) were male. The mean size of pancreatic masses was 35.3 17.1 mm (range 14-122.3 mm). Twenty eight patients (50%) had tumor at head/uncinate process of pancreas. There was no significant difference in procurement rate (for 25G 49/56 [87.5%] and for 22G 46/56 [82.1%], PZ0.599) and diagnostic accuracy (for 25G 98%, for 22G 95%). There were no technical failures or procedure related adverse events. Conclusion: Our study results confirm a trend towards a better procurement of histologic core and diagnostic accuracy for the 25-gauge needle though the difference was not significant. Furthermore, in a particular anatomic site, the 25-gauge needle could be recommended because it has a diagnostic accuracy similar to that of the 22-gauge needle but has fewer technical difficulties. Tu1650 Feasibility and Diagnostic Yield of a New EUS Guided Histology 20-Gauge Needle in the Evaluation of Intraintestinal and Extraintestinal Lesions Julio Iglesias-Garcia*, Priscilla A. Van Riet, Alberto Larghi, Marc Giovannini, Maria C. Petrone, Jose Larino-Noia, Jan-Werner Poley, Erwan Bories, Emanuele Dabizzi, Ihab Abdulkader, Genevieve M. Monges, Katharina Biermann, Guido Rindi, Claudio Doglioni, Guido Costamagna, Paolo G. Arcidiacono, Marco J. Bruno, Enrique Dominguez-Munoz Gastroenterology, University Hospital. Foundation for research in digestive diseases, Santiago de Compostela, Spain; Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, Netherlands; Digestive Endoscopy Unit, Catholic University, Rome, Italy; Endoscopic Unit, Paoli-Calmettes institut, Marseilles, France; Gastroenterology and Gastrointestinal Endoscopy Unit, Vita Salute San Raffaele University, Milan, Italy; Pathology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain; Foundation for research in digestive diseases, Santiago de Compostela, Spain; Pathology, Paoli-Calmettes institut, Marseilles, France; Pathology, Erasmus MC, University Medical Center, Rotterdam, Netherlands; Pathology, Vita Salute San Raffaele University, Milan, Italy; Pathology, Catholic University, Rome, Italy Background: Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is an accurate technique for sampling intraintestinal and extraintestinal lesions. However, cytology possesses certain limitations, which may be overcome if histological specimens are provided to the pathologist. The aim of the study was to evaluate the feasibility and accuracy of a newly developed 20-gauge histology needle. Methods: Retrospective analysis of a prospectively collected data base including patients who underwent EUS-guided biopsy with the 20-gauge ProCore histology needle with reverse bevel (3-HD-20) for the evaluation of intraintestinal or extraintestinal lesions. EUS procedures were performed under sedation with linear echoendoscopes (Olympus and Pentax). Samples recovered into cytological solution or formalin and processed for histological evaluation. Results were compared to the gold standard of surgical histopathology, or global pathological, clinical and radiological assessment, and follow-up in non-operated cases. Feasibility of the procedure and different technical aspects were recorded. Percentage of samples suitable for histological evaluation and the overall diagnostic accuracy were evaluated. Results are shown as mean and standard deviation or 95% confidence interval. Results: 51 patients (mean age 62.2 years, range 36-83 years, 26 male) were included. A total of 52 lesions were attempted to be sampled (mean size 31.88 12.4mm). Indications were pancreatic www.giejournal.org Vol mass (nZ30), intraabdominal lymph nodes (LN) (nZ6), subepithelial lesions (nZ6), liver mass (nZ3) and 1 cases of mediastinal LN, lung cancer, rectal mass, esophageal lesion, hiliar mass, intraabdominal mass and a left suprarenal gland mass. Lesions were accessed from esophagus in 3 cases, stomach in 27 cases, bulbous in 15 cases, second part of the duodenum in 6 cases and from the rectum in 1 case. EUS-guided biopsy was feasible in 50 cases (96.1%), with a mean of 1.7 passes (range 1-4). From 50 cases completed, sample quality was adequate for histological assessment in 46 lesions (92.0%). In the intention to treat analysis, diagnostic yield was 84.6% (95%CI: 72.5-91.9) and in per protocol analysis, diagnostic yield was 88.0% (95%CI 76.2-94.4). There were 2 (3.9%) mild complications (intraparietal hematomas at the place of FNB). Conclusion: The EUS-guided biopsy with the 20gauge Procore histology needle provides with a very good core sample for histological evaluation allowing a high histopathologic diagnostic accuracy. Tu1651 Diagnosis of Autoimmune Pancreatitis Using Endoscopic Ultrasound Guided Pancreatic Core Biopsy With Procore Needle Dongwook Oh*, Sang Soo Lee, Jin-Seok Park, Tae Young Park, Tae Jun Song, Do Hyun Park, Dong Wan Seo, Sung Koo Lee, Myung-Hwan Kim Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (the Republic of) Objective: Histologic diagnosis is important for the diagnosis of autoimmune pancreatitis (AIP). Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) has been performed to establish histologic diagnosis. To evaluate the usefulness of EUS-FNB using 19-gauge ProCore needles for the diagnosis of AIP. Methods: EUSFNB with 19-gauge ProCore needle was performed in 15 patients who were suspected with AIP between July 2012 and July 2014. These patients were classified based on the international consensus diagnostic criteria (ICDC). Results: The amount of obtained tissue samples was enough for histologic diagnosis. 15 patients were classified into type 1 AIP (nZ14; definite nZ10, probable nZ4), type 2 AIP (nZ1, definite). Based on the ICDC, 5 and 6 of 15 patients have level 1 (positive for 3 or 4 items) and level 2 (positive for 2 items) histological findings. 7 of 15 patients showed typical diffuse swelling on parenchymal imaging. Among them, 4 and 3 of 8 patients were positive for level 1 and level 2 histologic findings. 8 of 15 patients showed atypical imaging (low-density mass, segmental enlargement with delayed enhacement) on parenchymal imaging. Among these patients, 2 and 3 of 8 patients were positive for level 1 and level 2 histologic findings. There was no adverse events after procedure. Conclusions: EUS-FNB by using 19-gauge ProCore needle is a safe and useful for histologic diagnosis of AIP. Clinical findings of 15 patients ume 81, No. 5S : 2015 GASTROINTESTINAL ENDOSC Total (n[15)

Results of a Multicentric Study on EUS FNA of Pancreatic Tumors of Less than 3 cm in Diameter Marc Giovannini, Paolo Giorgio Arcidiacono, Christian Bergel, Genevieve Monges, Celso Ardghen, Simone Guaraldi, Pier Deprez, Roberto Fogel, Ionnis Karamboulis, Erwan Bories, V Moutadier, Marzia Rossi, JR Delpero The goal of this multicentric study was to evaluate the efficacy of EUS-FNA of small pancreatic masses (! 3 cm). 7 centers took part in this study. From May 2002 to May 2003, 155 patients (78M, 77F) of average age 60.72 yrs (range: 22-88 years) were included in the study. They presented a pancreatic tumour of less than 3 cm in diameter. 51/155 lesions were diagnosed only by EUS (32.9%). The average size of the pancreatic tumour was 21,12 mm (range: 6-29 mm). We noted 6 lesions of less than 10 mm, 16 between 10-15 mm, 31 between 15-20 mm, 37 between 20-25 mm and 65 of more than 25 mm. The tumour location:18 uncinate process, 74 head, 21 isthmus, 24 times body and 18 tail. The puncture was always carried out with a needle of 22 gauges (Wilson-Cook). 60/155 patients were operated (38.7%). The final diagnosis was done by EUS-FNA alone in 91 cases, by Surgery and EUS-FNA in 43 cases, by Surgery alone in 17 cases and by the follow-up in 4 cases. 4 benign complications occurred (epigastric pains 3 times, fever 1 time), they have all be regressive under medical treatment in less than 48 hours. EUS-FNA was no contributive in 17 cases (10.9%). The final diagnosis of the 155 pancreatic lesions was as follows: adenocarcinoma of the pancreas (n Z 88, 56.8%), endocrine tumour (n Z 34, 21.9%), cystadenoma (n Z 11, 7.1%), nodula of chronic pancreatitis (CCP) (n Z 13, 8.4%), pancreatic metastasis (n Z 4, 2.6%), benign tumour (n Z 4, 2.6%) and lymphoma (nZ 1, 0.6%). No EUS-FNA false positive was noted. For the diagnosis of malignancy, the sensitivity, specificity, the positive predictive value and the negative predictive value of the EUS-FNA were respectively 86.7%, 100%, 100% and 61.3%. The accuracy of the technique was 89%. If we compare the results according to the size (less 20 mm vs more than 20 mm) it exists a significant difference of accuracy (92.4% for let us injure of less 20 mm vs 87.2% for the tumours of more than 20 mm, p ! 0.001). In addition, the accuracy of EUSFNA is superior for the diagnosis of adenocarcinoma than for endocrine tumour (93.2% vs 70.6%, p! 0.001). On the other hand, there is no difference according to the localization of the tumour in pancreatic gland. EUS-FNA of small pancreatic tumours is feasible, sensitivity and specificity are equivalents to those of the series includin. W1174 Interobserver Agreement for EUS in the Evaluation and Diagnosis of Pancreatic Cystic Lesinos Seung Hoon Baek, Young Koog Cheon, Jun Hwan Wi, Dae Hee Han, In Seop Jung, Young Deok Cho, Jin Oh Kim, Jun Seong Lee, Moon Sung Lee, Chan Sup Shim Bacground/Aims: Endoscopic ultrasound (EUS) may provide detailed information regarding the morphology of cystic lesions and can be extremely helpful in ruling out a primary pancreatic lesion. However, the degree to which endosonographers agree on the diagnosis of pancreatic cystic lesions is reported rarely. We perfomed this study to evaluate the degree of agreement among endosonographers for EUS diagnosis of pancreatic cystic lesion and the variation in accuracy rates of endosonographers for diagnosis of pancreatic cystic lesion. Methods: Photograph series obtained from EUS examinations of 61 patients with cystic pancreatic lesions were reviewed by 3 experienced endosonographers. They were blinded to the clinical information and histopathologic results for each patient and reviewed each case solely for the presence or absence of previously defined features of cystic lesions of the pancreas. Interobserver agreement was expressed as the kappa ( ) statistic. Results: There were relatively poor overall agreement for the final diagnosis of pancreatic cystic mass (Z 0.486). Agreement for individual types of lesion was good for IPMT (Z 0.794) and serous cyst adenoma (Z 0.666) but poor for the remainder. Agreement was good for individual features of septation (Z 0.614), dilated pancreatic duct (Z 0.574), and solid component (Z 0.421) but poor for the other features. Accuracy rates of EUS for the diagnosis of pancreatic cystic mass ranged from 49% to 61%. EUS diagnosed IPMTand serous cystadenoma with high specificity but low sensitivity because that they were rule out easily without characteristic EUS features. Conclusions: Interobserver agreement is relatively poor for diagnosing pancreatic cystic mass by EUS. However, it appears to be better for some lesions than other. EUS morphology alone may not be adequate for discrimination between the various pancreatic cystic lesions. in addition studies assessing needle sampling, including the use histologic and biochemical markers of neoplasia are needed.