Endoscopic ultrasound-guided drainage of pancreatic fluid collections: The impact of evolving experience and new technologies in diagnosis and treatment over the last two decades

Background: Endoscopic ultrasound (EUS)-guided drainage is the preferred approach for drainage of pan- creatic uid collections (PFCs) due to the better experience and signi cant progress using newer stents and access devices during last decade. This study aimed to evaluate the role of the evolving experience and possible in uence of new technological devices on the outcome of patients evaluated for PFCs and submitted to EUS-guided drainage during two different periods: the early period at the beginning of experience when a standardized technique was used and the late period when the increased experience of the operator, combined with different stents quality were introduced in the management of PFCs. Methods: We retrospectively analyzed the clinical data of a cohort of 91 consecutive patients, who underwent EUS-guided drainage of symptomatic PFCs from October 2001 to September 2017. Demographic, therapeutic results, complications, and outcomes were compared between early years’ group (2001 2008) and late years’ group (2009 2017). Results: Endoscopic treatment was successfully achieved in 55.6% (20/36) of patients in the early years’ group, and in 96.4% (53/55) in the late years’ group. Eighteen patients (12 in early years’ and 6 in the late year’s group) required additional open surgery. Procedural complications were observed in 5 patients, 4 in early years’ and 1 in late years’ group. Mortality was registered in two patients (2.2%), one for each group. Conclusions: During our long-term survey using EUS-guided endoscopic drainage of PFCs, signi cantly better outcomes in term of improved success rate and decrease complications rate were observed during the late period.

Endoscopic ultrasound-guided fine-needle aspiration for suspected malignancies adjacent to the gastrointestinal tract

AIM:To investigate the impact of endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)in association with a multidisciplinary team evaluation for the detection of gastrointestinal malignancies.METHODS:A cohort of 1019 patients with suspected malignant lesions adjacent to the gastrointestinal tract received EUS-FNA after a standardized multidisciplinary team evaluation(MTE)and were divided into 4 groups according to their specific malignant risk score(MRS).Patients with a MRS of 0(without detectable risk of malignancy)received only EUS without FNA.For patients with a MRS score ranging from 1(low risk)-through 2(intermediate risk)-to 3(high risk),EUS-FNA cytology of the lesion was planned for a different time and was prioritized for those patients at higher risk for cancer.The accuracy,efficiency and quality assessment for the early detection of patients with potentially curable malignant lesions were evaluated for the whole cohort and in the different classes of MRSs.The time to definitive cytological diagnosis(TDCD),accuracy,sensitivity,specificity,positive and negative predictive values,and the rate of inconclusive tests were calculated for all patients and for each MRS group.RESULTS:A total of 1019 patients with suspected malignant lesions were evaluated by EUS-FNA.In 515patients of 616 with true malignant lesions the tumor was diagnosed by EUS-FNA;421 patients with resectable lesions received early surgical treatment,and 94patients received chemo-radiotherapy.The overall diagnostic accuracy for the 1019 lesions in which a final diagnosis was obtained by EUS-FNA was 0.95.When patients were stratified by MTE into 4 classes of MRSs,a higher rate of patients in the group with higher cancer risk(MRS-3)received early treatment and EUSFNA showed the highest level of accuracy(1.0).TDCD was also shorter in the MRS-3 group.The number of patients who received surgical treatment or chemo-radiotherapy was significantly higher in the MRS-3 patient group(36.3%in MRS-3,10.7%in MRS-2,and 3.5%in MRS-1).CONCLUSION:EUS-FNA can effectively detect a curable malignant lesions at an earlier time and at a higher rate in patients with a higher cancer risk that were evaluated using MTE.