title: EUS-guided FNA biopsy of the muscularis propria of the antrum in patients with gastroparesis is feasible and safe.
abstract: OBJECTIVE
  EUS-guided FNA biopsies of the muscularis propria of the gastric wall in patients with gastroparesis could replace the routine use of surgical full-thickness biopsies for assessing the loss of the interstitial cells of Cajal (ICCs) and cellular infiltrates in the myenteric plexus. We investigated the efficacy and safety of EUS-guided FNA biopsies of the muscularis propria of the gastric antrum in gastroparesis and compared the tissue with a surgically obtained full-thickness biopsy specimen in the same patient.
  
  
  METHODS
  This was a prospective, nonrandomized, feasibility trial. Patients with gastroparesis who were undergoing gastric neurostimulator placement were enrolled. Patients had a gastric wall measurement by radial EUS in the body and antrum of the stomach followed by linear EUS examination and FNA of the muscularis propria in the antrum by using a 19-gauge core needle. Within 24 hours, a full-thickness biopsy specimen of the antrum was obtained surgically during neurostimulator placement. Endoscopic and surgical specimens were compared for tissue morphology, number of ICCs (c-kit stain) and enteric neurons (S-100 stain), and fibrosis (trichome) for each patient. The correlation coefficient of the ICC count per high-power field was used to compare both specimens. Continuous data were compared by using a t test.
  
  
  RESULTS
  Eleven patients (10 female, 1 male), with a mean age of 40.6 years, were enrolled in the trial. EUS-guided core biopsies were successful in obtaining sufficient tissue for the histologic assessment of ICCs in 9 patients (81%) and for the myenteric plexus in 6 patients (54%). There was a good correlation coefficient (0.65) when both surgical and endoscopic groups were compared for the loss of ICCs. Mild serosal bruising and/or localized hematoma formations were noted at the sites of EUS biopsies, but there were no serosal tears, perforations, or adverse effects on the hospitalization and outcomes.
  
  
  CONCLUSIONS
  EUS-guided FNA of the gastric muscularis propria in patients with gastroparesis is safe and provides adequate tissue for full histologic assessment. (Clinical trial registration number: NCT01916460.).
authors: Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA.
authors: Mohamed O
authors: MO
authors: Othman
authors: Department of Surgery, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, Texas, USA.
authors: Brian
authors: B
authors: Davis
authors: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
authors: Irene
authors: I
authors: Saroseik
authors: Department of Pathology, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, Texas, USA.
authors: Alireza
authors: A
authors: Torabi
authors: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
authors: Richard W
authors: RW
authors: McCallum
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000000981:diagnostic imaging / Q000473:pathology*; D018589:Gastroparesis / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011706:Pyloric Antrum / Q000000981:diagnostic imaging / Q000473:pathology*; D015203:Reproducibility of Results; D013997:Time Factors; D055815:Young Adult