1. UTILITY OF ENDOSCOPIC ULTRASOUND-GUIDED FINE-NEEDLE ASPIRATION FOR THE DIAGNOSIS AND MANAGEMENT OF PANCREATIC CYSTIC LESIONS: DIFFERENCES BETWEEN THE GUIDELINES
Iwashita T, et al. Dig Endosc. 2020 Jan;32(2):251-262. doi: 10.1111/den.13579.
- The aim of this review was to evaluate the current status of EUS and EUS-FNA in the management of PCL and the status of these procedures in the guidelines.
Recent advances and frequent use of cross‐sectional imaging studies have increased opportunities for incidental diagnoses of pancreatic cystic lesions (PCL). In the management of PCL, distinguishing between mucinous versus non‐mucinous and malignant versus benign cysts is important to diagnose pancreatic cancer in its early stage. For this reason, there have been several guidelines to manage PCL. Endoscopic ultrasound (EUS) and EUS‐guided fine‐needle aspiration (FNA) play important roles in the guidelines, although there are some differences in their roles. In this review, we aimed to evaluate the current status of EUS and EUS‐FNA in the management of PCL and the status of these procedures in the guidelines.
2. COMPARISON BETWEEN FINE-NEEDLE BIOPSY AND FINE-NEEDLE ASPIRATION FOR EUS-GUIDED SAMPLING OF SUBEPITHELIAL LESIONS: A META-ANALYSIS
Facciorusso A, et al. Gastrointest Endosc. 2020;91(1):14–22.e2. doi:10.1016/j.gie.2019.07.018
- The aim of this study was to compare EUS-guided FNB sampling performance with FNA in GI subepithelial lesions.
- Meta-analysis; 10 studies and 669 patients included.
- Sample adequacy rate was 94.9% for FNB and 80.6% for FNA (p=0.007).
- Optimal histologic core procurement rate was 89.7% for FNB and 65% for FNA (p<0.0001).
- Diagnostic accuracy was significantly superior for FNB sampling (OR 4.10; p < .0001), with the need of a lower number of passes (mean difference, -.75; p=0.001).
- For GI subepithelial lesions, FNB sampling outperformed FNA in all diagnostic outcomes evaluated.
Background and aims: There is limited evidence on the diagnostic performance of EUS-guided fine-needle biopsy (FNB) sampling in patients with subepithelial lesions. The aim of this meta-analysis was to compare EUS-guided FNB sampling performance with FNA in patients with GI subepithelial lesions.
Methods: A computerized bibliographic search on the main databases was performed through May 2019. The primary endpoint was sample adequacy. Secondary outcomes were diagnostic accuracy, histologic core procurement rate, and mean number of needle passes. Summary estimates were expressed in terms of odds ratio (OR) and 95% confidence interval (CI).
Results: Ten studies (including 6 randomized trials) with 669 patients were included. Pooled rates of adequate samples for FNB sampling were 94.9% (range, 92.3%-97.5%) and for FNA 80.6% (range, 71.4%-89.7%; OR, 2.54; 95% CI, 1.29-5.01; P = .007). When rapid on-site evaluation was available, no significant difference between the 2 techniques was observed. Optimal histologic core procurement rate was 89.7% (range, 84.5%-94.9%) with FNB sampling and 65% (range, 55.5%-74.6%) with FNA (OR, 3.27; 95% CI, 2.03-5.27; P < .0001). Diagnostic accuracy was significantly superior in patients undergoing FNB sampling (OR, 4.10; 95% CI, 2.48-6.79; P < .0001) with the need of a lower number of passes (mean difference, -.75; 95% CI, -1.20 to -.30; P = .001). Sensitivity analysis confirmed these findings in all subgroups tested. Very few adverse events were observed and did not impact on patient outcomes.
Conclusions: Our results speak clearly in favor of FNB sampling, which was found to outperform FNA in all diagnostic outcomes evaluated.
3. ENDOSCOPIC ULTRASOUND-GUIDED GALLBLADDER DRAINAGE, TRANSPAPILLARY DRAINAGE, OR PERCUTANEOUS DRAINAGE IN HIGH RISK ACUTE CHOLECYSTITIS PATIENTS: A SYSTEMATIC REVIEW AND COMPARATIVE META-ANALYSIS
Mohan BP, et al. Endoscopy. 2020;52(2):96–106. doi:10.1055/a-1020-3932
- The aim of this study was to compare endoscopic transpapillary gallbladder drainage (ETGBD), EUS-guided gallbladder drainage (EUSGBD) and percutaneous gallbladder drainage (PCGBD) for patients with acute cholecystitis who are unfit for surgery.
- Systematic review and meta-analysis; 1223 patients (22 studies), 557 patients (14 studies), and 13 351 patients (46 studies) were treated by ETGBD, EUSGBD, and PCGBD, respectively.
- The technical and clinical success rates were: ETGBD 83% and 88.1%, EUSGBD 95.3% and 96.7%; and PCGBD 98.7% and 89.3%.
- Complications were comparable between the three groups.
- EUSGBD demonstrated better clinical success than ETGBD and PCGBD in the management of acute cholecystitis patients at high surgical risk.
Background: Endoscopic transpapillary gallbladder drainage (ETGBD) and endoscopic ultrasound-guided gallbladder drainage (EUSGBD) are alternatives to percutaneous gallbladder drainage (PCGBD) for patients with acute cholecystitis who are unfit for surgery. Data comparing these modalities are limited and have reported conflicting results.
Methods: We searched multiple databases from inception to May 2019 to identify studies that reported on ETGBD, EUSGBD, and PCGBD in the management of acute cholecystitis in patients with a high surgical risk. Aims were to compare the pooled rates of technical success, clinical success, adverse events, and disease recurrence.
Results: 1223 patients (22 studies), 557 patients (14 studies), and 13 351 patients (46 studies) were treated by ETGBD, EUSGBD, and PCGBD, respectively. The pooled technical and clinical successes were: ETGBD 83 % (95 % confidence interval [CI] 80.1 – 85.5, I 2 = 29) and 88.1 % (95 %CI 83.6 – 91.4, I 2 = 50), respectively; EUSGBD 95.3 % (95 %CI 92.8 – 96.9, I 2 = 0) and 96.7 % (95 %CI 94.0 – 98.2, I 2 = 0), respectively; and PCGBD 98.7 % (95 %CI 98.0 – 99.1, I 2 = 0) and 89.3 % (95 %CI 86.6 – 91.5, I 2 = 84), respectively. Clinical success with EUSGBD was significantly superior to the other approaches. All complications were comparable between the groups. Pancreatitis occurred with ETGBD in 5.1 % (95 %CI 3.5 – 7.3), whereas bleeding and perforation occurred with EUSGBD in 4.3 % (95 %CI 2.7 – 6.8) and 3.7 % (95 %CI 2.3 – 6.0), respectively. Stent migration occurred with PCGBD in 7.4 % (95 %CI 5.5 – 10.0).
Conclusion: EUSGBD demonstrated better clinical success than ETGBD and PCGBD in the management of acute cholecystitis patients at high surgical risk.