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. 2012 Jul;76(1):76-83.
doi: 10.1016/j.gie.2012.02.049.

Impact of biliary stents on EUS-guided FNA of pancreatic mass lesions

Nathaniel Ranney  1 , Milind Phadnis, Jessica Trevino, Jayapal Ramesh, C Mel Wilcox, Shyam Varadarajulu
Affiliations

Impact of biliary stents on EUS-guided FNA of pancreatic mass lesions

Nathaniel Ranney et al. Gastrointest Endosc. 2012 Jul.

Abstract

Background: Few studies have evaluated the impact of biliary stents on EUS-guided FNA.

Aim: To compare diagnostic yield of EUS-FNA in patients with or without biliary stents.

Design: Retrospective study.

Setting: Tertiary referral center.

Patients: Patients with obstructive jaundice secondary to solid pancreatic mass lesions who underwent EUS-FNA over 5 years.

Main outcome measures: The primary objective was to compare the diagnostic accuracy of EUS-FNA in patients with or without biliary stents and between patients with plastic stents or self-expandable metal stents (SEMSs). Secondary objectives were to assess the technical difficulty of EUS-FNA by comparing the number of passes required to establish diagnosis and to identify predictors of a false-negative diagnosis.

Results: Of 214 patients who underwent EUS-FNA, 150 (70%) had biliary stents and 64 (30%) had no stents in place. Of 150 patients with biliary stents, 105 (70%) were plastic and 45 (30%) were SEMSs. At EUS-FNA, the diagnosis was pancreatic cancer in 155 (72%), chronic pancreatitis in 17 (8%), other cancer in 31 (14%), and indeterminate in 11 (5%). There was no difference in rates of diagnostic accuracy between patients with or without stents (93.7% vs 95.3%; P = .73) and between plastic or SEMSs (95.2% vs 95.5%, P = .99), respectively. Median number of passes to diagnosis was not significantly different between patients with or without stents (2 [interquartile ratio range (IQR) = 1-3] vs 2 [IQR = 1-4]; P = .066) and between plastic or SEMS (2.5 [IQR = 1-4] vs 2 [IQR = 1-4], P = .69), respectively. On univariate analysis, EUS-FNA results were false-negative in patients with large pancreatic masses (>3 cm vs <3 cm, 9.35% vs 0.93%, P = .005) that required more FNA passes (<2 vs >2 passes, 0% vs 11.8%, P < .0001).

Limitations: Retrospective study.

Conclusions: The presence or absence of a biliary stent, whether plastic or metal, does not have an impact on the diagnostic yield or technical difficulty of EUS-FNA.

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Figures

Figure 1
Figure 1
EUS-guided FNA of a pancreatic mass in a patient with a biliary plastic stent. The needle is seen above the plastic stent, which appears hyperechoic.
Figure 2
Figure 2
EUS-guided FNA of a pancreatic head mass in a patient with a fully covered biliary self-expandable metal stent.
See this image and copyright information in PMC

Comment in

  • Endoscopic ultrasound.
    Perez-Miranda M, Vila JJ, De la Serna-Higuera C. Perez-Miranda M, et al. Endoscopy. 2013;45(4):300-4. doi: 10.1055/s-0032-1326272. Epub 2013 Feb 25. Endoscopy. 2013. PMID: 23440587 No abstract available.

References

    1. Eloubeidi MA, Varadarajulu S, Desai S, et al. A prospective evaluation of an algorithm incorporating routine preoperative endoscopic ultrasound-guided fine needle aspiration in suspected pancreatic cancer. J Gastrointest Surg. 2007;11:813–819. - PubMed
    1. Ross WA, Wasan SM, Evans DB, et al. Combined EUS with FNA and ERCP for the evaluation of patients with obstructive jaundice from presumed pancreatic malignancy. Gastrointest Endosc. 2008;68:461–466. - PubMed
    1. Fusaroli P, Manta R, Fedeli P, et al. The influence of endoscopic biliary stents on the accuracy of endoscopic ultrasound for pancreatic head cancer staging. Endoscopy. 2007;39:813–817. - PubMed
    1. Bao PQ, Johnson JC, Lindsey EH, et al. Endoscopic ultrasound and computed tomography of pancreatic cancer respectability. J Gasrointest Surg. 2008;12:10–16. - PubMed
    1. Cannon ME, Carpenter SL, Elta GH, et al. EUS compared with CT, magnetic resonance imaging, and angiography and the influence of biliary stenting on staging accuracy of ampullary neoplasms. Gastrointest Endosc. 1999;50:27–33. - PubMed

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