Giri Suprabhat, Afzalpurkar Shivaraj, Angadi Sumaswi, Varghese Jijo, Sundaram Sridhar
Department of Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India.
Institute of Gastrosciences and Liver, Apollo Multispecialty Hospital, Kolkata, India.
Clin Endosc. 2023 Mar;56(2):169-179. doi: 10.5946/ce.2022.282. Epub 2023 Feb 15.
BACKGROUND/AIMS: This meta-analysis analyzed the effect of an indwelling biliary stent on endoscopic ultrasound (EUS)-guided tissue acquisition from pancreatic lesions.
A literature search was performed to identify studies published between 2000 and July 2022 comparing the diagnostic outcomes of EUS-TA in patients with or without biliary stents. For non-strict criteria, samples reported as malignant or suspicious for malignancy were included, whereas for strict criteria, only samples reported as malignant were included in the analysis.
Nine studies were included in this analysis. The odds of an accurate diagnosis were significantly lower in patients with indwelling stents using both non-strict (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.52-0.90) and strict criteria (OR, 0.58; 95% CI, 0.46-0.74). The pooled sensitivity with and without stents were similar (87% vs. 91%) using non-strict criteria. However, patients with stents had a lower pooled sensitivity (79% vs. 88%) when using strict criteria. The sample inadequacy rate was comparable between groups (OR, 1.12; 95% CI, 0.76-1.65). The diagnostic accuracy and sample inadequacy were comparable between plastic and metal biliary stents.
The presence of a biliary stent may negatively affect the diagnostic outcome of EUS-TA for pancreatic lesions.
背景/目的：本荟萃分析旨在分析留置胆管支架对内镜超声（EUS）引导下胰腺病变组织获取的影响。
进行文献检索，以确定2000年至2022年7月期间发表的比较有或无胆管支架患者的EUS-TA诊断结果的研究。对于非严格标准，纳入报告为恶性或疑似恶性的样本，而对于严格标准，分析中仅纳入报告为恶性的样本。
本分析纳入了9项研究。使用非严格标准（优势比[OR]，0.68；95%置信区间[CI]，0.52 - 0.90）和严格标准（OR，0.58；95% CI，0.46 - 0.74）时，留置支架患者准确诊断的几率均显著降低。使用非严格标准时，有支架和无支架患者的合并敏感性相似（87%对91%）。然而，使用严格标准时，有支架患者的合并敏感性较低（79%对88%）。两组间样本不足率相当（OR，1.12；95% CI，0.76 - 1.65）。塑料和金属胆管支架在诊断准确性和样本不足方面相当。
胆管支架的存在可能对EUS-TA诊断胰腺病变的结果产生负面影响。
