Published online Aug 14, 2014. doi: 10.3748/wjg.v20.i30.10219
Revised: February 19, 2014
Accepted: April 30, 2014
Published online: August 14, 2014
The evaluation of ascites in patients with known or suspected malignancy is a critical aspect of preoperative staging. Endoscopic evaluation by ultrasound of low volume ascites and sampling of the ascitic fluid by endoscopic ultrasound guided paracentesis (EUS-P) is both a sensitive and specific modality for the determination of peritoneal implants, which is not only an important prognostic indicator but a crucial factor in determining treatment strategy. It is common practice to utilize EUS for gastrointestinal malignancies such as pancreatic or gastric masses, with the performance of paracentesis during the same procedure for the purpose of imaging the abnormality and possibly performing fine needle aspiration for biopsy of the neoplasm itself. However, given the ability of EUS-P to adequately sample even minimal ascites, detecting much smaller volumes than traditional computed tomography or magnetic resonance imaging, EUS-P may be a useful modality for the standard metastatic workup of any newly diagnosed or suspected malignancy. In this “Field of Vision” commentary, we discuss the role of EUS-P, including the article by Suzuki et al reporting their experience with EUS-P using an automated spring-loaded needle device. We also review the utility of EUS-P for non-gastrointestinal malignancies, such as ovarian cancer, which has a high incidence of malignant ascites.
Core tip: The diagnosis of metastatic disease by evaluation of ascites is crucial in the treatment strategy for suspected malignancy. Endoscopic ultrasound guided paracentesis is an accurate and useful diagnostic tool for the sampling of minimal amounts of ascites and should be considered during the staging workup of known or suspected malignancies.