There is limited evidence on the incidence of needle tract seeding (NTS) in patients undergoing endoscopic ultrasound (EUS) tissue acquisition (TA) of pancreatic lesions. This meta-analysis aimed to assess the incidence of NTS after EUS-TA. With a search of the literature up until April 2022, we identified 10 studies (13,238 patients) assessing NTS incidences in patients undergoing EUS-TA. The primary outcome was NTS incidence. The secondary outcome was a comparison in terms of peritoneal carcinomatosis incidence between patients who underwent EUS-TA and non-sampled patients. Results were expressed as pooled rates or odds ratio (OR) and 95% confidence intervals (CI). The pooled rate of NTS was 0.3% (95% CI 0.2–0.4%), with no evidence of heterogeneity (I2 = 0%). Subgroup analysis based on the type of sampled lesion confirmed this finding both in patients with pancreatic adenocarcinoma (0.4%, 0.2–0.6%) and in patients with cystic pancreatic lesions (0.3%, 0.1–0.5%). No difference in terms of metachronous peritoneal dissemination was observed between patients who underwent EUS-TA and non-sampled patients (OR 1.02, 0.72–1.46; p = 0.31), with evidence of low heterogeneity (I2 = 16%). Rates of NTS after EUS-TA are very low; therefore, EUS-TA could be safely performed in a pre-operative setting.

INTRODUCTION/AIM: Simple hepatic cysts (SHC) are usually asymptomatic and detected incidentally. However, larger cysts may present with clinical signs and require treatment such as percutaneous aspiration or surgery with non negligeable rate of recurrence. We report a series of 13 consecutive patients who underwent EUS guided Lumen Apposed Metal Stent (LAMS) drainage of symptomatic hepatic cysts of the right and left liver. METHODS: 9 Males, 4 Female, average age of 71.9 years underwent EUS guided LAMS cyst drainage because of significant symptoms. At one month, LAMS was changed for double pigtails stent (DPS) for three months. 9 were located in the right liver and four in the left. Diameter was on average 22,2 cm. RESULTS: 13 LAMS were successful delivered in all patients. However only in 12 out of 13 (92.3%) remained in place. In one case it slipped out immediately, was promptly removed and the cyst treated percutaneously. 1 out 12 presented bleeding and were treated conservatively. Only in 7 patients LAMS was removed for DPS, in the other 5 were successfully left in place until death given their comorbidities. At 10,5 months of follow up none recurred. CONCLUSION: EUS guided LAMS drainage permits treatment of symptomatic hepatic cysts without recurrence and with few adverse events. Studies of comparison are needed to consider this approach as first intention.

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