Endoscopic ultrasound-guided fine-needle aspiration of lesions near the aortoiliac bifurcation via an upper gastrointestinal approach

Background and Aims: Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) is widely used to investigate posterior mediastinal and upper abdominal lesions. Previously, we noticed that the aortoiliac bifurcation can be visualized by transduodenal EUS scanning, and the surrounding area might be a potential target for EUS-guided FNA. This study aimed to determine the feasibility of using EUS-guided FNA to study lesions near the aortoiliac bifurcation via the upper gastrointestinal approach. Methods: This study was a prospective pilot study of consecutive patients with a lesion of unknown origin near the aortoiliac bifurcation. Results: EUS-guided FNA was used in six patients. The aortoiliac bifurcation was visible from the inferior duodenal angle in all patients; however, the lesions could be visualized in only five patients (3 via the transduodenal approach, and 2 via the transgastric approach). In one patient with a lesion on the left side, the lesion could not be visualized by either the transgastric or transduodenal approach. In the other five patients, EUS-guided FNA was successful, and FNA specimens were adequate for histopathological assessment. The diagnoses were lymphoma (n=3), plasmacytoma (n=1), and neurinoma (n=1). All lymphoma cases were subclassified as diffuse large B-cell lymphoma (n=2) or grade 2 follicular lymphoma (n=1). No complications were observed. Conclusions: The aortoiliac bifurcation was visible in all patients by transduodenal EUS scanning. FNA of the legions near the aortoiliac bifurcation was possible in five of six patients by using either the transgastric or transduodenal approach.