Endo Go, Ishigaki Kazunaga, Hamada Tsuyoshi, Nakai Yousuke, Ishida Kota, Kurihara Kohei, Tange Shuichi, Takaoka Shinya, Tokito Yurie, Suzuki Yukari, Oyama Hiroki, Kanai Sachiko, Suzuki Tatsunori, Sato Tatsuya, Hakuta Ryunosuke, Saito Tomotaka, Takahara Naminatsu, Fujishiro Mitsuhiro
Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan.
Department of Chemotherapy the University of Tokyo Hospital Tokyo Japan.
DEN Open. 2023 Jul 10;4(1):e250. doi: 10.1002/deo2.250. eCollection 2024 Apr.
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is widely used for the pathological diagnosis of solid pancreatic lesions but in cases with obstructive jaundice, transpapillary sampling can be performed during endoscopic retrograde cholangiopancreatography with transpapillary biliary stent placement. Thus, it is still controversial whether EUS-FNA should be performed prior to endoscopic retrograde cholangiopancreatography with biliary stent placement or only after negative transpapillary sampling.
The accuracy, sensitivity, and specificity of EUS-FNA for solid pancreatic lesions with or without indwelling biliary stents were retrospectively studied in patients undergoing EUS-FNA between January 2017 and December 2021. We also conducted a meta-analysis including our data to compare the accuracy and sensitivity of EUS-FNA with or without biliary stents.
A total of 509 patients (40 with biliary stents and 469 without biliary stents) were included. The accuracy (77.5% vs. 94.5%, < 0.001) and sensitivity (71.0% vs. 91.7%, < 0.001) were lower in EUS-FNA with biliary stents. A meta-analysis confirmed that accuracy (odds ratio [OR] of 0.43, 95% confidence interval [CI] 0.29-0.62, < 0.001) and sensitivity (OR of 0.46, 95% CI 0.33-0.64, < 0.001) were lower in EUS-FNA with biliary stents. There were no statistically significant differences between plastic stents and self-expandable metallic stents for accuracy or sensitivity.
The presence of biliary stents had a negative impact on the diagnostic performance of EUS-FNA, and EUS-FNA prior to endoscopic retrograde cholangiopancreatography with biliary stent placement should be considered in cases with obstructive jaundice.
内镜超声引导下细针穿刺抽吸术（EUS-FNA）广泛用于实性胰腺病变的病理诊断，但在梗阻性黄疸病例中，可在内镜逆行胰胆管造影术期间进行经乳头采样并放置经乳头胆管支架。因此，EUS-FNA应在放置胆管支架的内镜逆行胰胆管造影术之前进行还是仅在经乳头采样阴性后进行仍存在争议。
回顾性研究2017年1月至2021年12月期间接受EUS-FNA的患者中，EUS-FNA对有或无留置胆管支架的实性胰腺病变的准确性、敏感性和特异性。我们还进行了一项荟萃分析，纳入我们的数据以比较有或无胆管支架时EUS-FNA的准确性和敏感性。
共纳入509例患者（40例有胆管支架，469例无胆管支架）。有胆管支架时EUS-FNA的准确性（77.5%对94.5%，<0.001）和敏感性（71.0%对91.7%，<0.001）较低。荟萃分析证实，有胆管支架时EUS-FNA的准确性（比值比[OR]为0.43，95%置信区间[CI]为0.29-0.62，<0.001）和敏感性（OR为0.46，95%CI为0.33-0.64，<0.001）较低。对于准确性或敏感性，塑料支架和自膨胀金属支架之间无统计学显著差异。
胆管支架的存在对EUS-FNA的诊断性能有负面影响，对于梗阻性黄疸病例，应考虑在放置胆管支架的内镜逆行胰胆管造影术之前进行EUS-FNA。
