Impact of biliary stenting in endoscopic ultrasound‐guided tissue acquisition among patients with pancreatic cancer

Abstract

Introduction Pancreatic malignancies represent highly fatal diseases with poor prognosis and constantly increasing incidence despite modern diagnostic and therapeutic options. Both endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are regarded as mainstays in pancreatic cancer management. The present study aims to evaluate whether accuracy EUS with fine‐needle aspiration or biopsy (FNA or FNB) in pancreatic cancer diagnosis is influenced by prior biliary stenting or by technical or anatomical features (stent type, number of needle passes, common bile duct or Wirsung's diameter, topographical characteristics and diameter of the pancreatic tumor). Materials and methods This retrospective study includes 243 patients with pancreatic cancer who underwent ERCP and EUS with fine‐needle aspiration or biopsy (FNA or FNB). Results and discussion Out of the total number of patients, 68 were stented prior to EUS. We found that the EUS‐FNA diagnostic yield is not influenced either by the presence of biliary stent, nor by the type of stent (plastic or metallic). Moreover, the mean needle passes required were similar for both stented patients and not stented ones. Conclusions Ultimately, given our results, we can state that EUS‐FNA/FNB can be safely and accurately performed in the presence of biliary stents.

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

“…Only four studies used strict criteria to define malignancy. 17 , 23 - 25 Tables 2 and 3 summarize the diagnostic outcomes for all studies based on the presence or absence of stents and stent type, respectively. 17 - 25 Supplementary Figure 1 presents the risk of bias assessment using the ROBINS-I tool.…”

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

“…From 91 studies identified using the search strategy, we included seven retrospective case-control studies [ 10 , 11 , 12 , 13 , 18 , 19 , 20 ] ( Figure 1 ) with 2458 patients.…”

“…Four studies were conducted in Europe [ 10 , 11 , 18 , 20 ] and three in the USA [ 12 , 13 , 19 ]. Patients were recruited between periods ranging from 1998 to 2020.…”

“…Based on six studies [ 10 , 11 , 12 , 13 , 18 , 20 ] (990 patients with biliary stents and 1200 without stents), the overall pooled diagnostic accuracy was 85.4% (95% CI 78.8–91.9%) and 88.1% (83.3–92.9%) in patients with and without biliary stenting, respectively. There was no significant difference between the two approaches (OR 0.74, 95% CI 0.53–1.02; p = 0.07).…”

Indwelling biliary stent during Endoscopic Ultrasound‐Guided Tissue Acquisition of pancreatic masses: Not necessarily a problem

“…In this issue of Journal of Clinical Ultrasound: Sonography and other Imaging Techniques , an interesting original research article by Constantinescu et al 6 addresses the impact of biliary stenting in EUS‐TA in patients affected by pancreatic cancer, assessing and comparing the accuracy of sampling pancreatic malignant tissue by means of EUS‐TA in patients who underwent prior ERCP with biliary stenting and patients in whom ERCP was not performed. A total of 243 patients with pancreatic cancer who underwent ERCP and EUS‐TA, either with Fine‐Needle Aspiration (FNA) or Fine‐Needle Biopsy (FNB), were retrospectively evaluated.…”