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. 2021 Jan;9(1):E66-E75.
doi: 10.1055/a-1293-7279. Epub 2021 Jan 1.

Diagnostic yield of endoscopic ultrasound-guided tissue acquisition in autoimmune pancreatitis: a systematic review and meta-analysis

Antonio Facciorusso  1 , Luca Barresi  2 , Renato Cannizzaro  3 , Filippo Antonini  4 , Konstantinos Triantafyllou  5 , Georgios Tziatzios  5 , Nicola Muscatiello  1 , Phil A Hart  6 , Sachin Wani  7
Affiliations

Diagnostic yield of endoscopic ultrasound-guided tissue acquisition in autoimmune pancreatitis: a systematic review and meta-analysis

Antonio Facciorusso et al. Endosc Int Open. 2021 Jan.

Abstract

Background and study aims There is limited evidence on the diagnostic performance of endoscopic ultrasound (EUS)-guided tissue acquisition in autoimmune pancreatitis (AIP). The aim of this meta-analysis was to provide a pooled estimate of the diagnostic performance of EUS-guided fine-needle aspiration (FNA) and fine-needle biopsy (FNB) in patients with AIP. Patients and methods Computerized bibliographic search was performed through January 2020. Pooled effects were calculated using a random-effects model by means of DerSimonian and Laird test. Primary endpoint was diagnostic accuracy compared to clinical diagnostic criteria. Additional outcomes were definitive histopathology, pooled rates of adequate material for histological diagnosis, sample adequacy, mean number of needle passes. Diagnostic sensitivity and safety data were also analyzed. Results Fifteen studies with 631 patients were included, of which four were prospective series and one randomized trial. Overall diagnostic accuracy of EUS tissue acquisition was 54.7 % (95 % confidence interval, 40.9 %-68.4 %), with a clear superiority of FNB over FNA (63 %, 52.7 % to 73.4 % versus 45.7 %, 26.5 %-65 %; p < 0.001). FNB provided level 1 of histological diagnosis in 44.2 % of cases (30.8 %-57.5 %) as compared to 21.9 % (10 %-33.7 %) with FNA ( P < 0.001). The rate of definitive histopathology of EUS tissue sampling was 20.7 % (12.9 %-28.5 %) and it was significantly higher with FNB (24.3 %, 11.8 %-36.8 %) as compared to FNA (14.7 %, 5.4 %-23.9 %; P < 0.001). Less than 1 % of subjects experienced post-procedural acute pancreatitis. Conclusion The results of this meta-analysis demonstrate that the diagnostic performance of EUS-guided tissue acquisition is modest in patients with AIP, with an improved performance of FNB compared to FNA.

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Conflict of interest statement

Competing interests Sachin Wani – Consultant for Boston Scientific, Medtronic, Interpace, Cernostics Sachin Wani – supported by the Department of Medicine Outstanding Early Scholars Program.The other authors do not have financial ties to disclose.

Figures

Fig. 1
Fig. 1
Flowchart of included studies.
Fig. 2
Fig. 2
Pooled analysis assessing the diagnostic accuracy of endoscopic ultrasound-guided tissue acquisition in patients with autoimmune pancreatitis. Overall diagnostic accuracy was 54.7 % (40.9 %–68.4 %; I 2  = 94.3 %).
Fig. 3
Fig. 3
Pooled analysis assessing rates of diagnostic accuracy achieved with a) fine-needle aspiration and b) fine-needle biopsy . Subgroup analysis performed according to the needle showed a superiority of fine-needle biopsy (FNB) over fine-needle aspiration (FNA) (63 %, 95 % CI, 52.7 % to 73.4 % versus 45.7 %, 26.5 % to 65 %; P  < 0.001). Of note, the high heterogeneity observed in the overall analysis was primarily observed in studies using FNA ( I 2  = 94.95 %) while only moderate heterogeneity was registered in the FNB analysis ( I 2  = 49 %).
Fig. 4
Fig. 4
Pooled analysis assessing the rate of definitive histopathology of endoscopic ultrasound-guided tissue acquisition in patients with autoimmune pancreatitis. Overall, the rate of definitive histopathology of endoscopic ultrasound-guided tissue acquisition was 20.7 % (12.9 %–28.5 %). Moderate evidence of heterogeneity was observed ( I 2  = 28.6 %).
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