{"id":3621,"date":"2019-09-03T09:24:08","date_gmt":"2019-09-03T09:24:08","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/10320\/"},"modified":"2023-03-13T16:36:37","modified_gmt":"2023-03-13T16:36:37","slug":"10320","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/artigoscomentados\/10320\/","title":{"rendered":"Qual agulha \u00e9 melhor para pun\u00e7\u00e3o ecoguiada do f\u00edgado ? FNA ou FNB ? Leia o ARTIGO COMENTADO !"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"3621\" class=\"elementor elementor-3621\">\n\t\t\t\t\t\t<section class=\"penci-section penci-disSticky penci-structure-10 elementor-section elementor-top-section elementor-element elementor-element-3f5d36cf elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"3f5d36cf\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"penci-ercol-100 penci-ercol-order-1 penci-sticky-ct    elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-1f922ecd\" data-id=\"1f922ecd\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4a7210a3 elementor-widget elementor-widget-text-editor\" data-id=\"4a7210a3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\tEndoscopy. 2019 Jul 23. doi: 10.1055\/a-0956-6922.\n\n<strong>\u00a0<\/strong>\n\n<strong>19\u200aG aspiration needle versus 19\u200aG core biopsy needle for endoscopic ultrasound-guided liver biopsy: a prospective randomized trial.<\/strong>\n\n&nbsp;\n\nChing-Companioni RA1, Diehl DL1, Johal AS1, Confer BD1, Khara HS1.\n\nDepartment of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States.\n\n&nbsp;\n\n<strong>Introdu\u00e7\u00e3o<\/strong>\n\n&nbsp;\n\nA doen\u00e7a hep\u00e1tica cr\u00f4nica tem v\u00e1rias causas e \u00e9 um importante fator de morbimortalidade. Embora exames laboratoriais e de imagem sejam \u00fateis na avalia\u00e7\u00e3o hepatica, eles podem n\u00e3o ser capazes de determinar sua etiologia e, em alguns casos, podem n\u00e3o conseguir estimar com precis\u00e3o o grau de fibrose hep\u00e1tica. A bi\u00f3psia continua sendo uma ferramenta importante no diagn\u00f3stico e tratamento de algumas doen\u00e7as cr\u00f4nicas do f\u00edgado. A bi\u00f3psia percut\u00e2nea ou pela via transjugular continuam sendo o padr\u00e3o ouro utilizado para obten\u00e7\u00e3o de fragmentos hep\u00e1ticos, por\u00e9m as bi\u00f3psias guiadas por ultrassonografia endosc\u00f3pica (EUS-LB) est\u00e3o sendo cada vez mais utilizadas. Um benef\u00edcio das bi\u00f3psias ecoguiadas \u00e9 a capacidade de executar com rapidez e seguran\u00e7a a obten\u00e7\u00e3o de fragmentos de ambos os lobos hep\u00e1ticos sob controle ultrassonogr\u00e1fico em tempo real durante todo o procedimento, minimizando o risco de pun\u00e7\u00e3o inadvertida de um vaso ou mesmo outro \u00f3rg\u00e3o. Outros benef\u00edcios potenciais incluem o conforto do paciente durante o procedimento, pois habitualmente o mesmo encontra-se sob seda\u00e7\u00e3o profunda, e maior efici\u00eancia e conveni\u00eancia para pacientes que necessitam de um bi\u00f3psia hep\u00e1tica, uma esofagogastroduodenoscopia e\/ou uma ecoendoscopia. V\u00e1rios estudos usando a pun\u00e7\u00e3o ecoguiada com aspira\u00e7\u00e3o com agulha fina (FNA) de 19 G mostraram a viabilidade e precis\u00e3o do dessa t\u00e9cnica, com rendimento superior a 90%. Um estudo retrospectivo comparando bi\u00f3psia hep\u00e1tica guiada por ecoendoscopia com bi\u00f3psias adquiridas pela via percut\u00e2nea ou transjugular mostrou que os diferentes m\u00e9todos eram compar\u00e1veis \u200b\u200bem termos de quantidade de tecido obtido. Pesquisas em andamento se concentram em como melhorar as amostras obtidas com esta t\u00e9cnica (EUS-LB). Os estudos iniciais com EUS-LB utilizaram uma agulha 19 G FNA ou a agulha TruCut 19 G (Merit Medical, South Jordan, Utah, EUA). Desde o desenvolvimento de agulhas para bi\u00f3psia guiada por EUS, esses dispositivos foram testados para EUS-LB, com resultados encorajadores. No entanto, nenhuma compara\u00e7\u00e3o prospectiva<em> in vivo<\/em> dessas agulhas tinha sido realizada. Neste estudo, objetivamos comparar o rendimento tecidual de uma agulha de EUS de 19 G (FNB) com o de uma agulha 19 G EUS (FNA) \u00a0em um estudo prospectivo randomizado. A hip\u00f3tese do nosso estudo foi que as agulhas de 19 G do tipo FNB proporcionaria melhores rendimentos teciduais do que a agulha FNA.\n\n&nbsp;\n\n<strong>M\u00e9todos<\/strong>\n\n&nbsp;\n\nEste foi um estudo prospectivo, paralelo, randomizado, comparando fragmentos de tecidos hep\u00e1ticos obtidos por dois tipos diferentes de agulhas de 19 G, FNA versus FNB.\n\nO desfecho prim\u00e1rio obtido foi o comprimento do fragmento. Os desfechos secund\u00e1rios foram, comprimento agregado da amostra, n\u00famero de tr\u00edades portais completas (CPTs) e eventos adversos.\n\nUma passagem transg\u00e1strica e uma transduodenal foram realizadas com a mesma agulha em cada paciente.\n\nOs comprimentos das amostras foram medidos antes e ap\u00f3s o processamento histol\u00f3gico.\n<p style=\"text-align: center;\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/Captura-de-Tela-2019-09-02-aCC80s-21.59.28.png\" data-rel=\"penci-gallery-image-content\" ><img fetchpriority=\"high\" decoding=\"async\" class=\"aligncenter size-full wp-image-10319\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/Captura-de-Tela-2019-09-02-aCC80s-21.59.28.png\" alt=\"\" width=\"618\" height=\"431\" \/><\/a><\/p>\n<p style=\"text-align: center;\"><em>Fragmentos obtidos logo ap\u00f3s a pun\u00e7\u00e3o. Foram peneirados com solu\u00e7\u00e3o salina<\/em><\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/Captura-de-Tela-2019-09-02-aCC80s-21.59.53.png\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" class=\"aligncenter size-full wp-image-10318\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/Captura-de-Tela-2019-09-02-aCC80s-21.59.53.png\" alt=\"\" width=\"617\" height=\"461\" \/><\/a><\/p>\n<p style=\"text-align: center;\"><em>Fragmentos posicionados ao lado de uma r\u00e9gua para aferi\u00e7\u00e3o do comprimento das amostras\u00a0<\/em><\/p>\n&nbsp;\n\n<strong>Resultados<\/strong>\n\n&nbsp;\n\nOs 40 pacientes encaminhados para realiza\u00e7\u00e3o das bi\u00f3psias guiadas por ecoendoscopia foram randomizados em dois grupos distintos.\n\nUm grupo foi submetido a FNA (n = 20) e outro foi submetido a FNB (n = 20).\n\nTodos os pacientes selecionados para o estudo eram portadores de alguma doen\u00e7a parenquimatosa cr\u00f4nica e foram submetidos a bi\u00f3psias de ambos os lobos hep\u00e1ticos.\n\nAs bi\u00f3psias de FNB produziram amostras m\u00e9dias mais longas (m\u00e9dia de pr\u00e9-processamento de 2,09 cm vs. m\u00e9dia 1,47 cm e p\u00f3s-processamento m\u00e9dio de 1,78 cm vs. m\u00e9dia 1,05 cm; (P &lt;0,001), e um comprimento agregado da amostra maior (m\u00e9dia de pr\u00e9-processamento de 15,78 cm vs. 10,89 cm; (P = 0,003) e mais CPTs (m\u00e9dia 42,6 vs 18,1; (P &lt;0,001) em compara\u00e7\u00e3o com a agulha FNA. N\u00e3o houve eventos adversos graves em nenhum dos grupos. A incid\u00eancia de efeitos adversos foi semelhante entre ambos. A\u00a0dor p\u00f3s-bi\u00f3psia foi observada em 30% dos que foram submetidos a FNB e 35% e a 30% no grupo da FNA, por\u00e9m sem diferen\u00e7a estatisticamente significativa.\n\n&nbsp;\n\n<strong>Conclus\u00e3o<\/strong>\n\n&nbsp;\n\nOs fragmentos obtidos atrav\u00e9s da pun\u00e7\u00e3o ecoguiada por FNB foram maiores, mais longos, e com uma maior quantidade de tr\u00edade portais completas do que o tecido obtido atrav\u00e9s de FNA.\u00a0 N\u00e3o houve diferen\u00e7a em rela\u00e7\u00e3o a incid\u00eancia de efeitos adversos entre os dois grupos estudados.\n\n&nbsp;\n\n<strong>Coment\u00e1rio<\/strong>\n\nA bi\u00f3psia transjugular ou percut\u00e2nea continuam sendo o padr\u00e3o-ouro para a obten\u00e7\u00e3o de fragmentos hep\u00e1ticos na avalia\u00e7\u00e3o da fibrose nas doen\u00e7as \u00a0cr\u00f4nicas do f\u00edgado. Por\u00e9m, com o advento das pun\u00e7\u00f5es ecoguiadas isso tende a mudar, j\u00e1 que esse m\u00e9todo apresenta diversas vantagens sobre os m\u00e9todos atualmente utilizados. Para citar algumas :\n\n&nbsp;\n<ul>\n \t<li>\u00c9 uma abordagem tecnicamente reprodut\u00edvel, independentemente do tipo corporal, pois a agulha necessita apenas atravessar a parede g\u00e1strica ou duodenal para alcan\u00e7ar o par\u00eanquima hep\u00e1tico;<\/li>\n \t<li>\u00c9 teoricamente menos dolorosa que a abordagem percut\u00e2nea, pois n\u00e3o requer pun\u00e7\u00e3o na parede abdominal;<\/li>\n \t<li>\u00c9 uma abordagem guiada por imagens em tempo real, que permite visualizar e evitar a pun\u00e7\u00e3o de vasos de tamanho t\u00e3o pequeno quanto 1 mm;<\/li>\n \t<li>Fornece acesso a uma \u00e1rea muito maior do par\u00eanquima hep\u00e1tico, pois todo o lobo esquerdo e a maioria do lobo direito podem ser avaliados para poss\u00edveis locais de pun\u00e7\u00e3o da agulha;<\/li>\n \t<li>Al\u00e9m de obter tecido, a bi\u00f3psia hep\u00e1tica guiada por ecoendoscopia tamb\u00e9m oferece o benef\u00edcio de uma avalia\u00e7\u00e3o abrangente do trato digestivo alto, incluindo rastreio ou acompanhamento de varizes esof\u00e1gicas.<\/li>\n<\/ul>\n&nbsp;\n\nPortanto, o atual artigo est\u00e1 entre tantos que corroboram a vantagem da pun\u00e7\u00e3o guiada por ecoendoscopia sobre os demais m\u00e9todos atualmente utilizados, e ainda, com o advento de novas agulhas (FNB) conseguimos com a mesma incid\u00eancia de efeitos colaterais, uma precis\u00e3o diagn\u00f3stica maior.<a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2019\/09\/acquire.jpeg\">\n<\/a>\n\n&nbsp;\n\n<strong><a href=\"https:\/\/www.thieme-connect.com\/products\/ejournals\/abstract\/10.1055\/a-0956-6922\" target=\"_blank\" rel=\"noopener noreferrer\">Clique aqui para acessar o artigo original !<\/a><\/strong>\n\n&nbsp;\n\nV\u00eddeo ilustrativo de um caso onde foram realizadas bi\u00f3psias hep\u00e1ticas por FNB.\n\n<div style=\"position:relative;padding-top:56.25%;\"><iframe id=\"panda-807959fa-a7bf-43ce-ba47-7bf8b6ce0005\" src=\"https:\/\/player-vz-a75e9d45-986.tv.pandavideo.com.br\/embed\/?v=807959fa-a7bf-43ce-ba47-7bf8b6ce0005\" style=\"border:none;position:absolute;top:0;left:0;\" allow=\"accelerometer;gyroscope;autoplay;encrypted-media;picture-in-picture\" allowfullscreen=true width=\"100%\" height=\"100%\" fetchpriority=\"high\"><\/iframe><\/div>\n\n&nbsp;\n\n&nbsp;\n\n<strong>Refer\u00eancias<\/strong>\n\n[1] Rockey DC, Caldwell SH, Goodman ZD et al. Liver biopsy. Hepatology 2009; 49: 1017 \u2013 1044\n\n[2] Rockey DC, Bissell DM. Noninvasive measures of liver fibrosis. Hepatology 2006; 43: S113 \u2013 S120\n\n[3] Rockey DC. Non-invasive assessment of liver fibrosis and portal hypertension with transient elastography. Gastroenterology 2008; 134: 8 \u2013 14\n\n[4] Ziol M, Handra-Luca A, Kettaneh A et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology 2005; 41: 48 \u2013 54\n\n[5] Parekh PJ, Majithia R, Diehl DL et al. Endoscopic ultrasound-guided liver biopsy. Endosc Ultrasound 2015; 4: 85 \u2013 91\n\n[6] Stavropoulos SN, Im GY, Jlayer Z et al. High yield of same-session EUSguided liver biopsy by 19-gauge FNA needle in patients undergoing EUS to exclude biliary obstruction. Gastrointest Endosc 2012; 75: 310 \u2013 318\n\n[7] Diehl DL, Johal AS, Khara HS et al. Endoscopic ultrasound-guided liver biopsy: a multicenter experience. Endosc Int Open 2015; 3: E1 \u2013 6\n\n[8] Schulman AR, Thompson CC, Odze R et al. Optimizing EUS-guided liver biopsy sampling: comprehensive assessment of needle types and tissue acquisition techniques. Gastrointest Endosc 2017; 85: 419 \u2013 426\n\n[9] Dewitt J, McGreevy K, Cummings O et al. Initial experience with EUS guided Tru-cut biopsy of benign liver disease. Gastrointest Endosc 2009; 69: 535 \u2013 542\n\n[10] Gor N, Salem SB, Jakate S et al. Histological adequacy of EUS-guided liver biopsy when using a 19-gauge non-Tru-Cut FNA needle. Gastrointest Endosc 2014; 79: 170 \u2013 172\n\n[11] Rocken C, Meier H, Klauck S et al. Large-needle biopsy versus thinneedle biopsy in diagnostic pathology of liver diseases. Liver 2001; 21: 391 \u2013 397\n\n[12] Sey MSL, Al-Haddad M, Imperiale TF et al. EUS-guided liver biopsy for parenchymal disease: a comparison of diagnostic yield between two core biopsy needles. Gastrointest Endosc 2016; 83: 347 \u2013 352\n\n[13] Gleeson FC, Clayton AC, Zhang L et al. Adequacy of endoscopic ultrasound core needle biopsy specimen of nonmalignant hepatic parenchymal disease. Clin Gastroenterol Hepatol 2008; 6: 1437 \u2013 1440\n\n[14] Pineda JJ, Diehl DL, Miao CL et al. EUS-guided liver biopsy provides diagnostic samples comparable with those via the percutaneous or transjugular route. Gastrointestinal Endosc 2016; 83: 360 \u2013 365\n\n[15] Nieto J, Khaleel H, Challita Y. EUS-guided fine-needle core liver biopsy sampling using a novel 19-gauge needle with modified 1-pass, 1 actuation wet suction technique. Gastrointest Endosc 2018; 87: 469 \u2013 475\n\n[16] Mok SRS, Diehl DL, Johal AS et al. A prospective pilot comparison of wet and dry heparinized suction for EUS-guided liver biopsy (with videos). Gastrointest Endosc 2018; 88: 919 \u2013 925\n\n[17] Schindelin J, Rueden CT, Hiner MC et al. The ImageJ ecosystem: an open platform for biomedical image analysis. Mol Reprod Dev 2015; 82: 518 \u2013 529\n\n[18] Cotton PB, Eisen GM, Aabakken L et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446 \u2013 454\n\n[19] Mok SR, Diehl DL, Johal AS et al. Endoscopic ultrasound-guided biopsy in chronic liver disease: a randomized comparison of 19-G FNA and 22-G FNB needles. Endosc Int Open 2019; 7: E62 \u2013 71\n\n[20] Attam R, Arain MA, Bloechl SJ et al. \u201cWet suction technique (WEST)\u201d: a novel way to enhance the quality of EUS-FNA aspirate. Results of a prospective, single-blind, randomized, controlled trial using a 22- gauge needle for EUS-FNA of solid lesions. Gastrointest Endosc 2015; 81: 1401 \u2013 1407\n\n[21] Diehl DL, Mok SRS, Khara HS et al. Heparin priming of EUS-FNA needles does not adversely affect tissue cytology or immunohistochemical staining. Endosc Int Open 2018; 6: E356 \u2013 E362\n\n[22] DeWitt J, LeBlanc J, McHenry L et al. Endoscopic ultrasound-guided fine needle aspiration cytology of solid liver lesions: a large single center experience. Am J Gastroenterol 2003; 98: 1976 \u2013 1981\n\n[23] Hollerbach S, Willert J, Topalidis T et al. Endoscopic ultrasound-guided fine-needle aspiration biopsy of liver lesions: histological and cytological assessment. Endoscopy 2003; 35: 743 \u2013 749\n\n[24] tenBerge J, Hoffman BJ, Hawes RH et al. EUS-guided fine needle aspiration of the liver: indications, yield, and safety based on an international survey of 167 cases. Gastrointest Endosc 2002; 55: 859 \u2013 862\n\n[25] Early DS, Acosta RD, Chandrasekhara V et al. Adverse events associated with EUS and EUS with FNA. Gastrointest Endosc 2013; 77960: 839 \u2013 843\n\n[26] Eisenberg E, Konopniki M, Veitsman E et al. Prevalence and characteristics of pain induced by percutaneous liver biopsy. Anesth Analg 2003; 96: 1392 \u2013 1396\n\n[27] Procopet B, Bureau C, M\u00e9tivier S et al. Tolerance of liver biopsy in a tertiary care center: comparison of the percutaneous and the transvenous route in 143 prospectively followed patients. Eur J Gastroenterol Hepatol 2012; 24: 1209 \u2013 1213\n\n&nbsp;\n\n&nbsp;\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Endoscopy. 2019 Jul 23. doi: 10.1055\/a-0956-6922. \u00a0 19\u200aG aspiration needle versus 19\u200aG core biopsy&hellip;<\/p>\n","protected":false},"author":4256,"featured_media":3622,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[142],"tags":[],"ano":[145],"tipo":[154],"volume":[147],"class_list":["post-3621","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artigoscomentados","ano-145","tipo-ecoendoscopia","volume-volume-ii"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Qual agulha \u00e9 melhor para pun\u00e7\u00e3o ecoguiada do f\u00edgado ? FNA ou FNB ? Leia o ARTIGO COMENTADO ! &#8226; Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/artigoscomentados\/10320\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Qual agulha \u00e9 melhor para pun\u00e7\u00e3o ecoguiada do f\u00edgado ? FNA ou FNB ? 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