Antibiotic Prophylaxis Is Not Required for Endoscopic Ultrasonography-Guided Fine-Needle Aspiration of Pancreatic Cystic Lesions, Based on a Randomized Trial

Colán-Hernández, Juan; Sendino, Oriol; Loras, Carme; Pardo, Albert; Gornals, Joan B.; Concepción, Mar; Sánchez-Montes, Cristina; Murzi, Marianette; Andújar, Xavier; Velasquez-Rodriguez, Julio G.; Miguel, Cristina Rodríguez de; Fernández‐Esparrach, Glòria; Ginés, Àngels; Guarner-Argente, Carlos

doi:10.1053/j.gastro.2020.01.025

Cited by 40 publications

(43 citation statements)

References 20 publications

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“…These were effective during the study period, and recommended antibiotic prophylaxis before and 3 to 5 days after EUS-FNA, although the conflicting evidence. Recent evidence from a randomized trial published in 2020, showed that antibiotic prophylaxis might not be needed at all before EUS-FNA of pancreatic cysts [29].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound with fine needle aspiration is useful in pancreatic cysts smaller than 3 cm

Faias

Cravo

Silva³

et al. 2020

BMC Gastroenterol

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Background In current guidelines, endoscopic ultrasound with fine-needle aspiration (EUS-FNA) is recommended in pancreatic cystic lesions (PCLs) with worrisome features (size ≥ 3 cm, mural nodule, or Wirsung dilation). Objective To evaluate the diagnostic ability and assess the accuracy of EUS-FNA in PCLs smaller than 3 cm. Methods Retrospective study of PCLs < 3 cm (2007–2016) undergoing EUS-FNA. Clinical, EUS and pancreatic cystic fluid (PCF) data were prospectively registered. Performance of EUS-FNA with PCF analysis for the detection of malignancy and accuracy in surgical cohort were analyzed. Results We evaluated 115 patients with PCLs < 3 cm who underwent EUS-FNA. 19 patients underwent surgery, 7 had malignant, 8 pre-malignant, and the remaining 4 benign lesions. Mass/mural nodule was present in 27% of the cysts, CEA level was higher than 192 ng/mL in 39.4% of patients, and only 35% of cytologic samples were informative. Nevertheless, additional FNA for PCF analysis improved the diagnostic performance of EUS imaging—AUC = 0.80 versus AUC = 60. Conclusion EUS-FNA has good accuracy in PCLs < 3 cm. It confirmed malignancy even in lesions without worrisome features (nodule/mass), with two in every five resections showing high-risk/malignant lesions. EUS-FNA was also useful to diagnose benign cysts, possibly allowing surveillance to be stopped in one in every five patients.

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Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound with fine needle aspiration is useful in pancreatic cysts smaller than 3 cm

Faias

Cravo

Silva³

et al. 2020

BMC Gastroenterol

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“…Recent randomized controlled trial suggests that there is no role of antibiotic prophylaxis before pancreatic cyst aspiration. 28 In the absence of a mass like lesion (mural nodule) and in presence of multiple cysts, the largest cyst alone is aspirated. If a different cyst needs to be aspirated, a new needle should be taken.…”

Section: Selection Of Needlementioning

confidence: 99%

EUS-Guided FNA: Tips and Tricks

Bansal

Puri

2020

Journal of Digestive Endoscopy

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AbstractThe development of endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) technique has been proved to be a great armamentarium to gastroenterologists and other branches including surgery, oncology, hepatology, pulmonary medicine, and internal medicine. EUS-FNA is quite safe and allows tissue acquisition from difficult anatomical locations like retroperitoneum, pancreas, and mediastinum. The current review discusses basic techniques steps of EUS-FNA including tips and tricks. Also, false negative FNA and EUS-FNA in difficult locations are discussed. We also discussed about EUS-guided fine needle biopsy.

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“…Puncture of cystic lesions is usually followed by antibiotic administration, acting as prophylaxis for infectious complications. Although this policy has been integrated into everyday worldwide clinical practice, its efficacy remains questionable, given the fact that the actual risk for infection remains very low (less than 1%) [ 26 ]. The latest ASGE guidelines suggest the use of prophylactic antibiotics only in cases of EUS-FNA of mediastinal and pancreatic cystic lesions; however, this was merely a weak recommendation, underlining the fact that data from prospective, randomized studies were lacking [ 27 ].…”

Section: Qis In the Pre-procedures Phasementioning

confidence: 99%

“…The latest ASGE guidelines suggest the use of prophylactic antibiotics only in cases of EUS-FNA of mediastinal and pancreatic cystic lesions; however, this was merely a weak recommendation, underlining the fact that data from prospective, randomized studies were lacking [ 27 ]. Indeed, the very first randomized trial evaluating the effect of antibiotic prophylaxis on the incidence of pancreatic cyst infection after EUS-FNA was only published very recently [ 26 ]. In this multicenter, randomized, non-inferiority trial conducted in Spain, prophylaxis with ciprofloxacin was compared against placebo administration in patients undergoing EUS-FNA for pancreatic cystic lesions.…”

Section: Qis In the Pre-procedures Phasementioning

confidence: 99%

Quality in pancreatic endoscopic ultrasound: what’s new in 2020?

Papanikolaou

Tziatzios

Gkolfakis

et al. 2020

aog

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Quality assessment and improvement of an endoscopic service has emerged as a basic component of everyday gastrointestinal endoscopy. In order to ensure a high level of quality, a series of actions must be adopted when performing an endoscopic examination. Nonetheless, quality still remains a qualitative parameter; thus, implementation of specific indicators of quality is warranted. Irrespective of the nature of the endoscopic procedure, quality indicators usually refer to either structural properties of an endoscopy unit (e.g., examination availability), procedural factors (e.g., diagnostic accuracy), or patient outcomes (e.g., occurrence of an adverse event related to performance of an endoscopic procedure). Moreover, they are usually classified into 3 distinct sections, according to the phase of the procedure they relate to: i.e., before, during, and after the examination. The aim of this review is to present measures that need to be adopted in order to reach an optimal quality level during an endoscopic ultrasound examination and to provide up-to-date data regarding the respective quality indicators implicated.

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Antibiotic Prophylaxis Is Not Required for Endoscopic Ultrasonography-Guided Fine-Needle Aspiration of Pancreatic Cystic Lesions, Based on a Randomized Trial

Cited by 40 publications

References 20 publications

Endoscopic ultrasound with fine needle aspiration is useful in pancreatic cysts smaller than 3 cm

Endoscopic ultrasound with fine needle aspiration is useful in pancreatic cysts smaller than 3 cm

EUS-Guided FNA: Tips and Tricks

Quality in pancreatic endoscopic ultrasound: what’s new in 2020?

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