A proposal for the ideal algorithm for the diagnosis, staging, and treatment of pancreas masses suspicious for pancreatic adenocarcinoma: Results of a working group of the Canadian Society for Endoscopic Ultrasound

Arya, Naveen; Wyse, Jonathan; Jayaraman, Shiva; Ball, Chad G.; Lam, Eric; Paquin, Sarto C.; Lightfoot, Peter C.; Sahai, Anand V.

doi:10.4103/eus.eus_28_20

Cited by 14 publications

(5 citation statements)

References 58 publications

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“… 27 However, the Canadian Society for EUS stated that EUS‑TA should precede ERCP. 28 No data on the endoscopist's preference for the first intervention, EUS, or ERCP were available. The present analysis aimed to assess the impact of indwelling biliary stents on the diagnostic outcomes of EUS-TA.…”

Section: Discussionmentioning

confidence: 99%

Influence of biliary stents on the diagnostic outcome of endoscopic ultrasound–guided tissue acquisition from solid pancreatic lesions: a systematic review and meta-analysis

Giri

Afzalpurkar²,

Angadi

et al. 2023

Clin Endosc

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Background/Aims: This meta-analysis analyzed the effect of an indwelling biliary stent on endoscopic ultrasound (EUS)–guided tissue acquisition from pancreatic lesions.Methods: A literature search was performed to identify studies published between 2000 and July 2022 comparing the diagnostic outcomes of EUS-TA in patients with or without biliary stents. For non-strict criteria, samples reported as malignant or suspicious for malignancy were included, whereas for strict criteria, only samples reported as malignant were included in the analysis.Results: Nine studies were included in this analysis. The odds of an accurate diagnosis were significantly lower in patients with indwelling stents using both non-strict (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.52–0.90) and strict criteria (OR, 0.58; 95% CI, 0.46–0.74). The pooled sensitivity with and without stents were similar (87% vs. 91%) using non-strict criteria. However, patients with stents had a lower pooled sensitivity (79% vs. 88%) when using strict criteria. The sample inadequacy rate was comparable between groups (OR, 1.12; 95% CI, 0.76–1.65). The diagnostic accuracy and sample inadequacy were comparable between plastic and metal biliary stents.Conclusions: The presence of a biliary stent may negatively affect the diagnostic outcome of EUS-TA for pancreatic lesions.

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Section: Discussionmentioning

confidence: 99%

Influence of biliary stents on the diagnostic outcome of endoscopic ultrasound–guided tissue acquisition from solid pancreatic lesions: a systematic review and meta-analysis

Giri

Afzalpurkar²,

Angadi

et al. 2023

Clin Endosc

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“…On the other hand, the international consensus for the endoscopic management of distal biliary strictures states that ERCP for relieving bile duct obstruction does not influence outcomes of EUS-TA. They further outline that performing ERCP first is appropriate for both diagnostic and therapeutic purposes in these patients [ 21 , 22 ]. Decompression via ERCP and biliary stenting often results in correcting underlying jaundice as well as provides relief from cholestatic pruritus.…”

Section: Discussionmentioning

confidence: 99%

Do Biliary Stents Affect EUS-Guided Tissue Acquisition (EUS-TA) in Solid Pancreatic Lesions Determining Biliary Obstruction? A Literature Review with Meta-Analysis

Facciorusso

Chandan

Gkolfakis

et al. 2023

Cancers

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There is a paucity of evidence regarding whether biliary stents influence endoscopic ultrasound-guided tissue acquisition using either fine-needle biopsy (EUS-FNB) or fine-needle aspiration (EUS-FNA), among patients with head of pancreas (HOP) lesions. We aimed at assessing the diagnostic accuracy of endoscopic ultrasound-guided tissue sampling in patients with or without bile duct stents. A total of seven studies with 2458 patients were included. The main aim was to assess overall pooled diagnostic accuracy. A pairwise meta-analysis was performed using a random effects model. Outcomes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). We found that pooled accuracy was 85.4% (CI 78.8–91.9) and 88.1% (CI 83.3–92.9) in patients with and without stents, respectively. There was no statistically significant difference between the two (OR 0.74; p = 0.07). Furthermore, patients with metal stents demonstrated a significant difference (OR 0.54, 0.17–0.97; p = 0.05), which was not seen with plastic stents. EUS-FNB showed poorer diagnostic accuracy with concurrent biliary stenting (OR 0.64, 0.43–0.95; p = 0.03); however, the same was not observed with EUS-FNA. Compared to plastic stents, metal biliary stenting further impacted the diagnostic accuracy of EUS-guided tissue acquisition for pancreatic head lesions. There was no difference in the rate of procedure-related adverse events between the stent and no-stent groups.

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“…In patients with distal biliary stricture, while international consensus statements 8 recommend ERCP‐guided tissue sampling should be first attempted when biliary drainage is required, another proposal 20 recommends EUS‐FNA first prior to ERCP. However, the sensitivity of transpapillary tissue sampling of biliary stricture is low, 7 and given the negative impact of indwelling biliary stents on the diagnostic yield of EUS‐FNA in our analysis, EUS‐FNA first approach prior to ERCP would be recommended for tissue sampling of SPLs with obstructive jaundice.…”

Section: Discussionmentioning

confidence: 99%

The impact of biliary stents on the diagnostic yield of endoscopic ultrasound‐guided fine needle aspiration for solid pancreatic lesions: A single‐center retrospective study and meta‐analysis

et al. 2023

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BackgroundEndoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) is widely used for the pathological diagnosis of solid pancreatic lesions but in cases with obstructive jaundice, transpapillary sampling can be performed during endoscopic retrograde cholangiopancreatography with transpapillary biliary stent placement. Thus, it is still controversial whether EUS‐FNA should be performed prior to endoscopic retrograde cholangiopancreatography with biliary stent placement or only after negative transpapillary sampling.MethodsThe accuracy, sensitivity, and specificity of EUS‐FNA for solid pancreatic lesions with or without indwelling biliary stents were retrospectively studied in patients undergoing EUS‐FNA between January 2017 and December 2021. We also conducted a meta‐analysis including our data to compare the accuracy and sensitivity of EUS‐FNA with or without biliary stents.ResultsA total of 509 patients (40 with biliary stents and 469 without biliary stents) were included. The accuracy (77.5% vs. 94.5%, p < 0.001) and sensitivity (71.0% vs. 91.7%, p < 0.001) were lower in EUS‐FNA with biliary stents. A meta‐analysis confirmed that accuracy (odds ratio [OR] of 0.43, 95% confidence interval [CI] 0.29–0.62, p < 0.001) and sensitivity (OR of 0.46, 95% CI 0.33–0.64, p < 0.001) were lower in EUS‐FNA with biliary stents. There were no statistically significant differences between plastic stents and self‐expandable metallic stents for accuracy or sensitivity.ConclusionsThe presence of biliary stents had a negative impact on the diagnostic performance of EUS‐FNA, and EUS‐FNA prior to endoscopic retrograde cholangiopancreatography with biliary stent placement should be considered in cases with obstructive jaundice.

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A proposal for the ideal algorithm for the diagnosis, staging, and treatment of pancreas masses suspicious for pancreatic adenocarcinoma: Results of a working group of the Canadian Society for Endoscopic Ultrasound

Cited by 14 publications

References 58 publications

Influence of biliary stents on the diagnostic outcome of endoscopic ultrasound–guided tissue acquisition from solid pancreatic lesions: a systematic review and meta-analysis

Influence of biliary stents on the diagnostic outcome of endoscopic ultrasound–guided tissue acquisition from solid pancreatic lesions: a systematic review and meta-analysis

Do Biliary Stents Affect EUS-Guided Tissue Acquisition (EUS-TA) in Solid Pancreatic Lesions Determining Biliary Obstruction? A Literature Review with Meta-Analysis

The impact of biliary stents on the diagnostic yield of endoscopic ultrasound‐guided fine needle aspiration for solid pancreatic lesions: A single‐center retrospective study and meta‐analysis

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