Cross-Sectional Study to Assess Endoscopic Ultrasound Practice in Portugal

Abstract

Background: Despite the increasing number of national departments performing endoscopic ultrasound (EUS), there are no official data regarding clinical EUS practice in Portugal. Objectives: We aimed to evaluate the current practice of EUS in Portugal. Methods: By email, we invited 1 physician of each one of the 26 national Gastroenterology Departments which perform EUS to complete a survey questionnaire available on the Google Forms platform. The online questionnaire was available from September 2017 until February 2018 and was answered only by physicians who perform EUS. Results: A total of 21/26 (80.8%) national Gastroenterology Departments answered the questionnaire. In Portugal, there are 42 echoendoscopes in total; most of the echoendoscopy units have only 1 EUS processor (81%), 1 radial echoendoscope (66.7%), 1 linear echoendoscope (76.2%), 1 anorectal probe (57.1%), but no miniprobes (85.7%). About 81% have histological core acquisition needles. In 81% of the units, there are at least 2 ultrasonographers who perform echoendoscopy together (at least 2 ultrasonographers per EUS) in 47.6% of these departments. The ultrasonographers also performed abdominal ultrasound (US), anal US, and endoscopic retrograde cholangiopancreatography in 71.4, 66.7, and 42.9%, respectively. The echoendoscopy units have 2.4 ± 1.1 periods of echoendoscopy per week and 4 ± 1.5 EUS per period (499.2 ± 416.8 EUS per year). Subepithelial lesions and biliopancreatic lesion evaluation as well as gastrointestinal neoplasia staging were the most common EUS indications. The number of FNA (fine-needle aspirations) ranges from 10 to 160/year. Rapid on-site evaluation (ROSE) is available in 60% of units and is performed by the cytopathologist (66.7%) in the majority of cases. The main reason for omitting ROSE is the limited pathology staff. Cytopathological material is prepared by the ultrasonographer in 25% of the units. Air drying (50%) and formalin (50%) are most frequently used to fix and preserve smears, respectively. Pancreatic pseudocyst drainage (66.7%), celiac plexus neurolysis (52.4%) and pancreatic necrosectomy (42.9%) are the most widespread therapeutic procedures. Conclusions: This survey provides the first insight into the current status of digestive echoendoscopy in Portugal. There is a great variability in diagnostic and therapeutic echoendoscopy practice.

Keywords

• Endoscopic ultrasound
• Echoendoscopy
• Portugal
• Survey questionnaire