Shang Guochen, He Qi, Han Chaoqun, Guo Xianwen, Chen Weigang, Ding Zhen, Lin Rong
Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China.
Department of Gastroenterology, The First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang Uyghur Autonomous Region, China.
Endosc Ultrasound. 2024 Sep-Oct;13(5):287-292. doi: 10.1097/eus.0000000000000082. Epub 2024 Nov 6.
Although the impact of biliary stents on the accuracy of EUS-guided tissue acquisition (EUS-TA) is still controversial, the influence of biliary-pancreatic double stents on EUS-TA is even more inconclusive. The aim of the study was to determine whether the diagnostic yield of EUS-FNA in the diagnosis of solid pancreatic lesions will be affected after placement of biliary-pancreatic double stents.
A multicenter retrospective study including patients who underwent EUS-FNA with biliary duct obstruction was performed. Patients were divided into 2 groups according to whether there were biliary-pancreatic double stents before EUS-FNA. The patients' EUS-FNA report, histopathological results, and clinical case data were reviewed and compared.
Ninety-two patients were included, 42 with biliary-pancreatic double stents and 50 without any stents. The puncture time taken by EUS-FNA was significantly longer in the stent group than the no-stent group (19 15 min, < 0.001). No significant differences were observed in accuracy (90.5% 94%), sensitivity (89.5% 93.6%), specificity (100% 100%), NPV (50% 50%), PPV (100% 100%), respectively, in both groups. Patients with larger lesions (OR = 1.600, 95% CI: 1.124-2.277) and those who required more passes had a higher diagnostic yield (OR = 9.376, 95% CI: 1.356-64.819) by multivariate analysis.
ERCP before EUS-FNA is feasible for the treatment of solid pancreatic lesions causing obstructive jaundice. It will not have a negative impact on the diagnostic accuracy and surgical complications, but the EUS-FNA operation time will be prolonged.
尽管胆道支架对超声内镜引导下组织获取术（EUS-TA）准确性的影响仍存在争议，但胆胰双支架对EUS-TA的影响更尚无定论。本研究旨在确定放置胆胰双支架后，EUS-FNA对实性胰腺病变的诊断率是否会受到影响。
进行一项多中心回顾性研究，纳入接受超声内镜引导下细针穿刺活检（EUS-FNA）且伴有胆管梗阻的患者。根据EUS-FNA术前是否放置胆胰双支架将患者分为两组。回顾并比较患者的EUS-FNA报告、组织病理学结果及临床病例资料。
共纳入92例患者，其中42例放置了胆胰双支架，50例未放置任何支架。支架组EUS-FNA的穿刺时间显著长于无支架组（19±15分钟，P<0.001）。两组在准确性（90.5%对94%）、敏感性（89.5%对93.6%）、特异性（100%对100%）、阴性预测值（50%对50%）、阳性预测值（100%对100%）方面均未观察到显著差异。多因素分析显示，病变较大的患者（OR = 1.600，95%CI：1.124 - 2.277）以及需要更多穿刺针数的患者诊断率更高（OR = 9.376，95%CI：1.356 - 64.819）。
EUS-FNA术前进行内镜逆行胰胆管造影术（ERCP）治疗引起梗阻性黄疸的实性胰腺病变是可行的。它不会对诊断准确性和手术并发症产生负面影响，但EUS-FNA的操作时间会延长。
