Assessment of morbidity and mortality associated with endoscopic ultrasound‐guided fine‐needle aspiration for pancreatic cystic lesions: A systematic review and meta‐analysis

Zhu, Huiyun; Jiang, Fei; Zhu, Jianwei; Jin, Zhendong; Li, Zhao‐Shen

doi:10.1111/den.12851

Cited by 81 publications

(77 citation statements)

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“…Endoscopic ultrasound‐FNA of cystic fluid from pancreatic cysts has been carried out to differentiate between malignant and benign lesions and between mucinous and non‐mucinous cysts . EUS‐FNA has been recommended for pancreatic cysts >15 mm in size .…”

Section: Methodsmentioning

confidence: 99%

“…Endoscopic ultrasound-FNA of cystic fluid from pancreatic cysts has been carried out to differentiate between malignant and benign lesions and between mucinous and nonmucinous cysts. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] EUS-FNA has been recommended for pancreatic cysts >15 mm in size. 13 Adverse events of EUS-FNA included bleeding in 0.2-6% of patients and infections in 0.2-5%.…”

Section: Endoscopic Ultrasound-guided Fine-needle Aspirationmentioning

confidence: 99%

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Endoscopic diagnosis of cystic lesions of the pancreas

Kamata

Kitano

2018

Digestive Endoscopy

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Endoscopic methods are increasingly used in the diagnosis of cystic lesions of the pancreas. The two major endoscopic approaches are endoscopic ultrasonography (EUS) and transpapillary diagnosis. EUS-guided fine-needle aspiration cytology and EUS-guided fine needle-based confocal laser endomicroscopy have been used in the differential diagnosis of mucinous and non-mucinous pancreatic cysts. EUS is the most sensitive modality for detecting mural nodules (MN) in intraductal papillary mucinous neoplasms (IPMN). Contrast-enhanced harmonic EUS (CH-EUS), as an add-on to EUS, is useful for identifying and characterizing MN. Recent studies show that CH-EUS has a sensitivity of 60-100% and a specificity of 75-92.9% for diagnosing malignant cysts. Intraductal ultrasonography and peroral pancreatoscopy are especially useful for detecting MN and IPMN. A recent meta-analysis showed that cytological assessment of pancreatic juice using a transpapillary approach had a pooled sensitivity, specificity, and accuracy of 35.1%, 97.2%, and 92.9%, respectively, for diagnosing malignant IPMN. Further studies are warranted to determine the indications for each of these novel techniques in assessing cystic lesions of the pancreas.

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Section: Methodsmentioning

confidence: 99%

Section: Endoscopic Ultrasound-guided Fine-needle Aspirationmentioning

confidence: 99%

Endoscopic diagnosis of cystic lesions of the pancreas

Kamata

Kitano

2018

Digestive Endoscopy

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“…FNA itself also has a certain risk of adverse events. A meta‐analysis of 40 articles evaluating morbidity and mortality associated with EUS‐FNA for PCL showed overall morbidity of 2.66% (95% CI, 1.84–3.62) and associated mortality of 0.19% (95% CI, 0.09–0.32) and also showed common post‐procedure adverse events including pancreatitis (0.92%, 95% CI, 0.63–1.28), hemorrhage (0.69%, 95% CI: 0.42–1.02), pain (0.49%, 95% CI: 0.27–0.79%), infection (0.44%, 95% CI: 0.27–0.66), desaturation (0.23%, 95% CI: 0.12–0.38) and perforation (0.21%, 95% CI: 0.11–0.36%) . The overall adverse event rate was relatively low; however, most studies did not include long term follow‐up data.…”

Section: Eus‐fna For Differential Diagnosis and Detection Of Malignanmentioning

confidence: 99%

Utility of endoscopic ultrasound and endoscopic ultrasound‐guided fine‐needle aspiration for the diagnosis and management of pancreatic cystic lesions: Differences between the guidelines

Iwashita

Uemura

Mita

et al. 2019

Digestive Endoscopy

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Recent advances and frequent use of cross‐sectional imaging studies have increased opportunities for incidental diagnoses of pancreatic cystic lesions (PCL). In the management of PCL, distinguishing between mucinous versus non‐mucinous and malignant versus benign cysts is important to diagnose pancreatic cancer in its early stage. For this reason, there have been several guidelines to manage PCL. Endoscopic ultrasound (EUS) and EUS‐guided fine‐needle aspiration (FNA) play important roles in the guidelines, although there are some differences in their roles. In this review, we aimed to evaluate the current status of EUS and EUS‐FNA in the management of PCL and the status of these procedures in the guidelines.

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“…Although EUS‐FNA is recommended in PCL with worrisome features, it is rarely carried out in Japan because of the risk of dissemination. However, it all comes down to the risk and benefit balances . There is a risk of peritoneal dissemination, albeit low, in EUS‐FNA for any lesions, either solid or cystic.…”

mentioning

confidence: 99%

“…However, it all comes down to the risk and benefit balances. 10 There is a risk of peritoneal dissemination, albeit low, in EUS-FNA for any lesions, either solid or cystic. However, if the diagnostic yield is high enough and clinical management changes according to the results of EUS-FNA, or EUS-TTNB, it should be the standard of care for the diagnosis of PCL.…”

mentioning

confidence: 99%