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The Clinical Utility of Evaluating the Luminal Upper Gastrointestinal Tract During Linear Endoscopic Ultrasonography

Kim, Stephen MD; Hamerski, Chris MD; Ghassemi, Kourosh MD; Shah, Janak MD; Bhat, Yasser MD; Klapman, Jason MD; Komanduri, Sri MD; Keswani, Rajesh N. MD; Bidari, Kiran MD; Wani, Sachin MD; Watson, Rabindra R. MD; Muthusamy, Venkataraman R. MD, FACG, FASGE

Journal of Clinical Gastroenterology: August 2016 - Volume 50 - Issue 7 - p 538–544
doi: 10.1097/MCG.0000000000000434
ALIMENTARY TRACT: Original Articles

Background: The clinical utility of performing esophagogastroduodenoscopy (EGD) before linear endoscopic ultrasonography (L-EUS) to evaluate the luminal upper gastrointestinal (GI) tract is not well established.

Goals: The study was aimed to determine the prevalence of clinically meaningful luminal abnormalities (any luminal finding requiring further evaluation with mucosal biopsy or initiation of treatment) in patients undergoing L-EUS. The study also sought to compare the ability of the gastroscope and the linear echoendoscope in identifying these lesions.

Study: A prospective, multicenter cohort study enrolled patients undergoing L-EUS for nonluminal indications. All patients underwent EGD followed by L-EUS by 2 different endoscopists. The second endoscopist was blinded to the results of the initial EGD. The identification of clinically meaningful luminal lesions and quality of endoscopic visualization of the upper GI tract were measured.

Results: In the cohort of 175 patients, 52 (29.7%) patients had clinically meaningful luminal findings seen in the upper GI tract. There was no significant difference in the number of clinically meaningful lesions identified on EGD and L-EUS (25.1% vs. 22.9%, P=0.39). No significant difference was found in the miss rate of clinically meaningful lesions between the 2 modalities (EGD: 4.5% vs. EUS: 6.9%, P=0.39).

Conclusions: A substantial minority of patients undergoing L-EUS for nonluminal indications will have clinically meaningful luminal findings. The endoscopic evaluation of the luminal upper GI tract can be adequately achieved using the linear echoendoscope.

*Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles

California Pacific Medical Center, San Francisco, CA

Moffitt Cancer Center, Tampa, FL

§Division of Gastroenterology and Hepatology, Feinberg School of Medicine at Northwestern University, Chicago, IL

Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO

The authors declare that they have nothing to disclose.

Address correspondence to: Venkataraman R. Muthusamy, MD, FACG, FASGE, David Geffen School of Medicine at UCLA, UCLA Medical Center, 200 UCLA Medical Plaza, Suite 330-37, Los Angeles, CA 90095 (e-mail:

Received April 24, 2015

Accepted September 14, 2015

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.