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.
