Crinò Stefano Francesco, Conti Bellocchi Maria Cristina, Antonini Filippo, Macarri Giampiero, Carrara Silvia, Lamonaca Laura, Di Mitri Roberto, Conte Elisabetta, Fabbri Carlo, Binda Cecilia, Ofosu Andrew, Gasparini Enrico, Turri Chiara, Stornello Caterina, Celsa Ciro, Larghi Alberto, Manfrin Erminia, Gabbrielli Armando, Facciorusso Antonio, Tacelli Matteo
Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy.
Gastroenterology and Digestive Endoscopy Unit, Augusto Murri Hospital, Polytechnic University of Marche, Fermo, Italy.
Endosc Ultrasound. 2021 Nov-Dec;10(6):440-447. doi: 10.4103/EUS-D-21-00118.
There is no clear evidence of a negative impact of biliary stents on the diagnostic yield of EUS-guided fine-needle biopsy (EUS-FNB) for diagnosing pancreatic head lesions. We aimed to evaluate the association between the presence of biliary stents and the diagnostic accuracy of EUS-FNB.
A multicenter retrospective study including all jaundiced patients secondary to pancreatic head masses was performed. Patients were divided into two groups according to the presence of a biliary stent placed before EUS-FNB. Pathological results were classified according to the Papanicolaou classification and compared against the final diagnosis. Diagnostic measures in the two groups were compared. Multivariate logistic regression analyses including potential factors affecting EUS-FNB accuracy were performed.
Overall, 842 patients were included, 495 (58.8%) without and 347 (41.2%) with biliary stent. A plastic or a metal stent was placed in 217 (62.5%) and 130 (37.5%) cases, respectively. Diagnostic sensitivity and accuracy were significantly higher in patients without biliary stent than in those with stent (91.9% and 92.1% vs. 85.9% and 86.4%, P = 0.010 At multivariate analyses, lesion size (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.02-1.09, P = 0.01) and presence of biliary stent (OR: 0.51, 95% CI: 0.32-0.89, P = 0.01) were independently associated with diagnostic accuracy. In the subgroup of patients with biliary stent, the type of stent (plastic vs. metal) did not impact EUS-FNB yield, whereas the use of larger bore needles enhanced diagnostic accuracy (OR: 2.29, 95% CI: 1.28-4.12, P = 0.005).
In this large retrospective study, an indwelling biliary stent negatively impacted the diagnostic accuracy of EUS-FNB. Preferably, EUS-FNB should precede endoscopic retrograde cholangiopancreatography, especially in the case of small tumors.
目前尚无明确证据表明胆管支架对超声内镜引导下细针穿刺活检（EUS-FNB）诊断胰头病变的诊断率有负面影响。我们旨在评估胆管支架的存在与EUS-FNB诊断准确性之间的关联。
进行了一项多中心回顾性研究，纳入所有因胰头肿块导致黄疸的患者。根据EUS-FNB前是否放置胆管支架将患者分为两组。病理结果根据巴氏分类法进行分类，并与最终诊断结果进行比较。比较两组的诊断指标。进行多因素逻辑回归分析，纳入影响EUS-FNB准确性的潜在因素。
总体共纳入842例患者，495例（58.8%）未放置胆管支架，347例（41.2%）放置了胆管支架。分别有217例（62.5%）和130例（37.5%）放置了塑料或金属支架。未放置胆管支架患者的诊断敏感性和准确性显著高于放置支架的患者（91.9%和92.1%对85.9%和86.4%，P = 0.010）。在多因素分析中，病变大小（比值比[OR]：1.05，95%置信区间[CI]：1.02-1.09，P = 0.01）和胆管支架的存在（OR：0.51，95% CI：0.32-0.89，P = 0.01）与诊断准确性独立相关。在放置胆管支架的患者亚组中，支架类型（塑料与金属）不影响EUS-FNB的取材成功率，而使用较大内径的穿刺针可提高诊断准确性（OR：2.29，95% CI：1.28-4.12，P = 0.005）。
在这项大型回顾性研究中，留置胆管支架对EUS-FNB的诊断准确性有负面影响。最好在进行内镜逆行胰胆管造影之前先进行EUS-FNB，尤其是对于小肿瘤的情况。
