Endoscopic ultrasound-guided forceps biopsy from upper gastrointestinal subepithelial lesions using a forward-viewing echoendoscope

Background and study aims: Endoscopic tissue acquisition techniques using needle-knife and biopsy forceps allow abundant tissue acquisition from upper gastrointestinal subepithelial lesions; however, these techniques cannot capture real-time intratumor information. The aim of this study was to evaluate the feasibility of endoscopic ultrasound-guided forceps biopsy (EUS-FB) from upper gastrointestinal subepithelial lesions using a forward-viewing echoendoscope. Patients and methods: This study was a prospective case series. After mucosal cuts, several specimens were taken using a hot biopsy forceps under real-time EUS visualization. The incision was closed using hemoclips. Diagnostic yield, rate of diagnosable samples obtained under EUS visualization, procedure time, and adverse events were assessed. Results: Ten patients (median lesion size 16 mm, range 15 – 44 mm) underwent EUS-FB. The overall rate of histological diagnosis by EUS-FB was 100 % (10/10). The rate of diagnosable samples among all cases was 97.6 % (41/42). The median procedure times for EUS-FB and complete closure were 28.5 and 4.5 minutes, respectively. No adverse events occurred. Conclusions: This newly developed EUS-FB is feasible and allowed forceps biopsy from upper gastrointestinal subepithelial lesions. Study registration: UMIN000015364