Role of EUS Guided FNA of Portal Vein Thrombus in the Diagnosis and Staging of Hepatocellular Carcinoma
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|ClinicalTrials.gov Identifier: NCT03902678|
Recruitment Status : Recruiting
First Posted : April 4, 2019
Last Update Posted : April 4, 2019
Since not every portal vein thrombus (PVT) in a patient with hepatocellular carcinoma (HCC) is a tumor thrombus, since the nature of the thrombus will ultimately determine the course of treatment, and since PVT may be even the initial sign of an undetected HCC, every effort should be made to distinguish between a tumor and a non-tumor PVT. In addition, malignant PVT does not always demonstrate neovascularity and/or enhancement, which makes fine needle aspiration (FNA) necessary in order to characterize the nature of the PVT.
Sampling of portal vein thrombus with trans-abdominal ultrasound guidance may lead to erroneous results because of inadvertent inclusion of normal hepatocytes or associated liver masses. Further, potential adverse events of trans-abdominal portal vein sampling include serious biliary and/or vascular injury.
In contrast to the percutaneous approach, Endoscopic ultrasound (EUS) provides a unique view and access to the main portal vein. From the duodenal bulb and second part of the duodenum, the portal vein can be visualized from the confluence of the splenic and superior mesenteric veins into the porta hepatis. Periportal collateral vessels or cavernous transformation of the portal vein, which commonly are associated with portal vein thrombosis, are also easily and reliably detected by EUS instruments with color Doppler US capability.
With a linear-array echo-endoscope, the portal vein can be punctured easily with a fine needle under direct visualization, while avoiding the adjacent hepatic artery, bile duct, and collateral vessels (if present). Because the approach is not trans-hepatic, it eliminates any need to avoid the primary tumor and any possibility of contaminating the specimen with hepatocytes, as can occur if the needle tracks through the liver parenchyma. Thus, the rate of false-positive diagnoses is likely to be lower with the EUS compared with the percutaneous approach
|Condition or disease||Intervention/treatment||Phase|
|Portal Vein Thrombosis||Procedure: EUS guided fine needle aspiration of portal vein thrombus||Not Applicable|
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||30 participants|
|Intervention Model:||Single Group Assignment|
|Intervention Model Description:||Use of histopathology obtained from endoscopic ultrasound -fine needle aspiration of portal vein thrombus for identification of malignant thrombus which did not fulfill criteria of malignancy by abdominal ultrasound and triphasic abdominal CT|
|Masking:||None (Open Label)|
|Official Title:||Role of Endoscopic Ultrasound Guided Fine Needle Aspiration of Portal Vein Thrombus in the Diagnosis and Staging of Hepatocellular Carcinoma|
|Actual Study Start Date :||May 11, 2017|
|Estimated Primary Completion Date :||May 11, 2019|
|Estimated Study Completion Date :||July 11, 2019|
Experimental: EUS - FNA for benign PVT by imaging
Intervention: Procedure/Surgery: EUS guided fine needle aspiration of portal vein thrombus
Procedure: EUS guided fine needle aspiration of portal vein thrombus
endoscopic ultrasound guided fine needle aspiration of portal vein thrombus which did not fulfill criteria of malignancy by imaging technique
- Percentage of patients with bland portal vein thrombosis diagnosed by triphasic abdominal CT who are proven to have malignant cells by histopathology obtained via EUS-guided FNA [ Time Frame: 3 days up to 2 weeks ]Histopathology of biopsies taken from bland portal vein thrombus which diagnosed by triphasic CT abdomen to evaluate the possibility of malignant PVT that was not discovered by imaging technique (Abdominal ultrasound and triphasic abdominal CT )
- Percentage of patients with portal vein thrombosis who underwent EUS guided FNA and had complications as a result of the invasive maneuver [ Time Frame: 2 days ]assessment of safety of the procedure ( The patients admitted and the new ones will be admitted to specialized medical hospital for 24 h after the procedure to exclude the possibility of bleeding at puncture site, risk of biliary peritonitis, and extravasation from the site of the thrombus.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03902678
|Contact: Dina S. Eskanderefirstname.lastname@example.org|
|Contact: Ahmad Y. Altonbary, MD||01005100091||Altonbary@gmail.com|
|specialized medical hospital, Mansourah University||Recruiting|
|Mansourah, Dakahlia, Egypt, 35516|
|Contact: dina S. eskandere, Master 01148979995 email@example.com|
|Principal Investigator: Dina S. Eskandere, Master|
|Sub-Investigator: Ahmad Y. Altonbary, MD|
|Sub-Investigator: Hazem H. ElBeltagy, MD|
|Sub-Investigator: Magdy H. Atwa, Professor|
|Study Chair:||Magdy H. Atwa, Professor||Faculty of Medicine, Mansoura University|