EUS-guided through the needle microbiopsy: a useful adjunct in the investigation of pancreatic cystic lesions

Ahmed, Wafaa; Mirzaali, Mikaeil; Young, Caroline; Sanni, Latifu; Everett, Simon; Paranandi, Bharat; Huggett, Matthew T.; On, Wei

doi:10.1136/bmjgast-2023-001184

Cited by 3 publications

(1 citation statement)

References 35 publications

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“…EUS-TTNB is one of the most recent and promising techniques for the definition of PCLs, with excellent technical success (98.5%, CI 97.3-99.6%) and high accuracy (86.7%, CI 80.1-93.4) according to a recent metanalysis [15]. Several studies have compared TTNB to standard EUS-FNA, with conventional fluid analysis demonstrating the clear superiority of TTNB in risk stratification and its ability to provide a specific diagnosis [8,9,[11][12][13][38][39][40][41][42][43][44][45][46][47][48]. Moreover, a study demonstrated that EUS-TTNB specimens are suitable for molecular analyses [49].…”

Section: Discussionmentioning

confidence: 99%

Rare Pancreatic/Peripancreatic Cystic Lesions Can Be Accurately Characterized by EUS with Through-the-Needle Biopsy—A Unique Pictorial Essay with Clinical and Histopathological Correlations

Conti Bellocchi,

Manfrin,

Brillo

et al. 2023

Diagnostics

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Due to their aspecific macroscopic appearance, uncommon pancreatic cystic lesions (PCLs) are often misdiagnosed as mucinous lesions and improperly resected. We aimed to evaluate the endoscopic ultrasound (EUS)-guided through-the-needle biopsy (TTNB) capacity of the preoperative diagnosis of uncommon PCLs. Overall, 136 patients with PCLs who underwent EUS-TTNB between 2016 and 2022 were retrospectively identified. Common histotypes (e.g., IPMN, serous cystadenoma, and mucinous cystadenoma) were excluded and 26 (19.1%) patients (15 female, mean age 52.9 ± 10.4) were analyzed. The EUS findings, adverse events (AEs), and TTNB outcomes in uncommon PCLs were evaluated. The cysts histotype was accurately diagnosed by TTNB in 24/26 (92.3%) cases (seven cystic neuroendocrine tumors, four squamoid cysts, three acinar cells cystadenomas, two lymphoepithelial cysts, two mucinous non-neoplastic cysts, two bronchogenic cysts, two cystic lymphangiomas, one solid-pseudopapillary neoplasm, and one schwannoma). In the remaining two cases, lymphangioma was eventually diagnosed after resection. Surgery was performed in 15/26 (57.7%) patients. The mean follow-up of non-surgical patients was 32.5 months. One severe acute case of pancreatitis (3.8%) that required surgery occurred after EUS-TTNB. Uncommon pancreatic/peripancreatic lesions represent the 19.1% of PCLs in our series, with mainly benign histotypes. TTNB demonstrated a high diagnostic performance with a low rate of AEs in this setting, representing a reliable tool with which to avoid useless surgery.

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Section: Discussionmentioning

confidence: 99%

Rare Pancreatic/Peripancreatic Cystic Lesions Can Be Accurately Characterized by EUS with Through-the-Needle Biopsy—A Unique Pictorial Essay with Clinical and Histopathological Correlations

Conti Bellocchi,

Manfrin,

Brillo

et al. 2023

Diagnostics

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Risk of Pancreatitis After Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis

Magahis,

Chhoda,

Berzin

et al. 2024

Am J Gastroenterol

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Background: Endoscopic ultrasound-guided fine-needle-aspiration (EUS-FNA) is frequently used to risk-stratify pancreatic cystic lesions (PCLs). Rising PCL incidence and developments in tissue acquisition and specimen analysis necessitate updated appraisal of EUS-FNA safety, particularly the risk of post-procedure pancreatitis, the most common EUS-FNA-related adverse event. Our systematic review aims to accurately quantify the risk of EUS-FNA-related pancreatitis to best inform decisions regarding EUS-FNA’s optimal role in PCL workup. Methods: We performed systematic searches in four databases from inception to April 2024 for original English-language studies investigating EUS-FNA-related pancreatitis. We extracted data on demographics and EUS-FNA-related pancreatitis risk, severity, and risk factors. These were meta-analyzed through the DerSimonian Laird Method using a random-effects model. Meta-regression of pancreatitis risk was performed to delineate associations with clinical and procedural characteristics. Results: Sixty-four studies comprised 8086 patients and reported 110 EUS-FNA-related pancreatitis events. Pooled risk of EUS-FNA-related pancreatitis was 1.4% [95% CI, -0.8-3.5%; I 2 = 0.00], which was predominantly of mild severity (67%) and uniformly non-fatal. Pancreatitis risk lacked significant association with sample size, age, sex, cyst size, needle caliber or passes, although we noted trends towards higher risk in studies published after 2015, those using higher gauge needles (19G vs. 22G/25G), and those performing EUS-TTNB. Conclusions: We note with high certainty that pancreatitis following EUS-FNA of PCLs is infrequent and mild in severity with no mortality in the included cohort. EUS-TTNB may serve as a significant risk factor for EUS-FNA-related pancreatitis risk; however, further studies are needed to delineate other predisposing characteristics.

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Endoscopic techniques for the diagnosis of pancreatic cystic lesions

Singh,

Chandan,

Vinayek

et al. 2025

World J Gastroenterol

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Pancreatic cysts are mostly incidental findings on computed tomography or magnetic resonance imaging scans, with few patients presenting with abdominal pain or other symptoms. The accurate diagnosis of cysts is important as management depends on the type (neoplastic or non-neoplastic). Cross-sectional imaging is fast being replaced with endoscopic ultrasound (EUS) and various techniques based on that such as EUS-guided fine needle aspiration, EUS-guided needle confocal laser endomicroscopy, EUS-through-the-needle biopsy, and contrast-enhanced EUS. Clinical studies have reported varying diagnostic and adverse event rates with these modalities. In addition, American, European, and Kyoto guidelines for the diagnosis and management of pancreatic cysts have provided different recommendations. In this editorial, we elaborate on the clinical guidelines, recent studies, and comparison of different endoscopic methods for the diagnosis of pancreatic cysts.

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EUS-guided through the needle microbiopsy: a useful adjunct in the investigation of pancreatic cystic lesions

Cited by 3 publications

References 35 publications

Rare Pancreatic/Peripancreatic Cystic Lesions Can Be Accurately Characterized by EUS with Through-the-Needle Biopsy—A Unique Pictorial Essay with Clinical and Histopathological Correlations

Rare Pancreatic/Peripancreatic Cystic Lesions Can Be Accurately Characterized by EUS with Through-the-Needle Biopsy—A Unique Pictorial Essay with Clinical and Histopathological Correlations

Risk of Pancreatitis After Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis

Endoscopic techniques for the diagnosis of pancreatic cystic lesions

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