1. Lumen apposing metal stents in drainage of pancreatic walled-off necrosis, are they any better than plastic stents? A systematic review and meta-analysis of studies published since the revised Atlanta classification of pancreatic fluid collections

Mohan BP, et al. Endosc Ultrasound. 2019;8(2):82-90.

Key points

  • The aim this meta-analysiswas to compare the rates of clinical success and adverse events between lumen-apposing metal stents (LAMS) and plastic stents (PS) in the drainage of pancreatic walled-off necrosis (WON);
  • 9 studies (737 patients) for LAMS and 6 studies (527 patients) for PS were included;
  • The rate of clinical success was identical (LAMS 88.5% vs PS 88.1%, P=0.93);
  • The rate of adverse events was also similar (LAMS 11.2% vs PS 15.9%, P=0.38);
  • This study demonstrates that LAMS and PS demonstrate equal clinical outcomes and equal adverse-events in the drainage of pancreatic WON.

Abstract

Lumen-apposing metal stents (LAMS) are increasingly being used in the drainage of pancreatic walled-off necrosis (WON). Best choice of stent is subject to argument, and studies are varied in the reported outcomes between LAMS and plastic stents (PS) to this end.

We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed, EMBASE, and Web of Science databases (earliest inception through July 2018) to identify studies that reported on the use of LAMS and PS in WON drainage. Studies published since the release of the revised Atlanta classification for pancreatic fluid collections (2014 to current) were included in the analysis. The outcomes were to estimate and compare the pooled rates of clinical success, and adverse-events.

A total of 9 studies (737 patients) for LAMS and 6 studies (527 patients) for PS were included in the analysis. The pooled rate of clinical success with LAMS was 88.5% (95% CI 82.5-92.6, I2 = 71.7) and with PS was 88.1% (95% CI 80.5-93.0, I2 = 78.1) and the difference was not statistically significant, P = 0.93. No difference was noted in the pooled rates of all adverse-events, LAMS: 11.2% (6.8-17.9, I2 = 82.0); vs PS: 15.9% (8.4-27.8, I2 = 78.8); P = 0.38. Based on our meta-analysis, LAMS and PS demonstrate equal clinical outcomes and equal adverse-events in the drainage of pancreatic WON.

 

2. Performance of a new preloaded fiducial needle to guide radiation therapy of upper gastrointestinal cancers

Phan VA, et al. Endoscopy. 2019;51(5):463-467.

Key points

  • The aim of this study was to compare the performance of a new EUS-guided preloaded fiducial needle against Visicoil fiducials;
  • Prospective study; 60 patients with upper gastrointestinal cancers were included (14 Visicoil, 46 preloaded fiducials);
  • The two techniques had a technical success of 100 % and no major complications, but the new preloaded fiducial needle had a shorter insertion time (mean 0.94 vs 5.5 minutes, P < 001), a higher visibility score on fluoroscopy (2 vs 1.18, P < 0.001) and lower costs (mean 480 vs 643 US dollars,P < 0.001).

Abstract

Background: Insertion of fiducials to outline the targeted lesion allows image-guided radiotherapy, and is best achieved by endoscopic ultrasound (EUS). This study is a performance comparison of the new EUS-guided preloaded fiducial needle against Visicoil fiducials.

Methods: Technical success, visibility score, procedural time, costs, and complications for patients who underwent EUS-guided fiducial placement in upper gastrointestinal malignancies were prospectively collected.

Results: 60 patients with upper gastrointestinal cancers had fiducials (14 Visicoil; 46 preloaded fiducials) inserted for image-guided radiotherapy. Technical success was 100 %, with a shorter mean (standard deviation) insertion time of 0.94 minutes (0.28 minutes) vs. 5.5 minutes (1.9 minutes; P < 0.001) and higher visibility score on fluoroscopy of 2 vs. 1.18 (P < 0.001) in the preloaded group. Neither group had major complications related to fiducial insertion. The cost of consumables per patient was lower in the preloaded group at US$480 (US$124) vs. US$643 (US$123; P < 0.001).

Conclusion: Fiducial insertion for image-guided radiotherapy using the new preloaded needle is associated with 100 % technical success, shorter insertion time, and higher visibility, and is more cost-effective than the Visicoil system.

 

3. A multicenter evaluation of a new EUS core biopsy needle: Experience in 200 patients

Adler DG, et al. Endosc Ultrasound. 2019;8(2):99-104.

Key points

  • The aim of this study was to analyze the performance of a new EUS-FNB needle – Acquire (Boston Scientific, Natick, MA) when sampling solid lesions
  • Multicenter retrospective study, 200 patients were included and lesions included were solid pancreatic masses (109), adenopathy (45), submucosal lesions (34), cholangiocarcinoma (8), liver lesions (6), and other (8);
  • The mean lesion size was 30.6 mm, the mean number of passes per target lesion was 3 and there were no adverse events;
  • Tissue obtained was adequate for evaluation and diagnosis by ROSE in 98.5% cases (197/200) and a core of tissue was obtained in 90.3% cases (131/145);
  • This new EUS-FNB needle showed a high rates of tissue adequacy and tissue core acquisition with no adverse events in this study; comparative studies of different FNB needles are needed.

Abstract

Background and Objectives: We present a multicenter study of a new endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) needle (Acquire, Boston Scientific, Natick, MA). The aim of the study was to analyze the needle’s clinical performance when sampling solid lesions and to assess the safety of this device.
Methods: We performed a multicenter retrospective study of patients undergoing EUS-FNB during July 1–November 15, 2016.
Results: Two hundred patients (121 males and 79 females) underwent EUS-FNB of solid lesions with the Acquire needle. Lesions included solid pancreatic masses (n = 109), adenopathy (n = 45), submucosal lesions (n = 34), cholangiocarcinoma (n = 8), liver lesions (n = 6), and other (n = 8). Mean lesion size was 30.6 mm (range: 3–100 mm). The mean number of passes per target lesion was 3 (range: 1–7). Rapid onsite cytologic evaluation (ROSE) by a cytologist was performed in all cases. Tissue obtained by EUS-FNB was adequate for evaluation and diagnosis by ROSE in 197/200 cases (98.5%). Data regarding the presence or absence of a core of tissue obtained after EUS-FNB were available in 145/200 procedures. In 131/145 (90%) of cases, a core of tissue was obtained. Thirteen out of 200 patients (6.5%) underwent some form of repeat EUS-based tissue acquisition after EUS-FNB with the Acquire needle. There were no adverse events.
Conclusion: Overall, this study showed a high rate of tissue adequacy and production of a tissue core with this device with no adverse events seen in 200 patients. Comparative studies of different FNB needles are warranted in the future to help identify which needle type and size is ideal in different clinical settings.