The efficacy of rapid on-site evaluation during endoscopic ultrasound-guided fine needle aspiration of pancreatic masses

Background:Endoscopic ultrasound(EUS)-guided fine needle aspiration(FNA)has become the preferred method to diagnose pancreatic masses due to its minimally invasive approach and diagnostic accuracy.Many studies have shown that rapid on-site evaluation(ROSE)improves diagnostic yield by 10–30%;however,more recent studies have demonstrated effective diagnostic accuracy rates without ROSE.Our study aims to examine whether the current standard of performing ROSE after each FNA pass adds diagnostic value during EUS-guided FNA of pancreatic masses.Methods:We conducted a retrospective case series on patients who underwent EUS-guided FNA of pancreatic masses between February 2011 and October 2014.All cases were performed by one of three endoscopists at Emory University Hospital.Patient demographics,radiologic details of pancreatic masses and pathology reports of the biopsied pancreatic masses were examined.Results:A total of 184 procedures performed in 171 patients were reviewed.The final pathology reports of the biopsied pancreatic masses showed 128(70%)with confirmed malignancy.Only 64(50%)of these 128 cases initially showed malignant cells during ROSE.Among these 64 cases,23%required 5 or more FNA passes to first detect malignant cells.Conclusions:The use of ROSE during EUS-guided FNA of pancreatic masses may increase the diagnostic yield,since malignant cells were often detected during later FNA passes that would otherwise be missed if tissue sampling stopped prematurely.In addition,sample preparation for ROSE may be suboptimal,since malignant cells were only detected in 50%of cases.

Endoscopic retrograde cholangiopancreatography with ampullary biopsy vs ERCP alone:a matched-pairs controlled evaluation of outcomes and complications

Background and aims:Biopsy of the ampulla of Vatermay be performed to evaluate for ampullary adenomas,suspected ampullary tumors and immunohistological staining for autoimmune pancreatitis.Ampullary biopsies are commonly performed at the time of endoscopic retrograde cholangiopancreatography(ERCP).Due to the well-established complication rate following ERCP,the contribution of ampullary biopsy as a potential independent risk factor would require a controlled comparison.Methods:A matched-pairs,case-control analysis was performed for patients undergoing ERCP with or without ampullary biopsy.The analysis involved a retrospective review of adult patients at a tertiary-care center who underwent ampullary biopsies during ERCP compared(via procedural complexity)with a matched control group who underwent ERCP without ampullary biopsies.Results:Of 159 procedures involving ampullary biopsy,54 ERCPs that met the inclusion criteria were performed with ampullary biopsy and included in the analysis cohort.This cohort was compared with 54 patients undergoing ERCP without ampullary biopsy,matched by American Society for Gastrointestinal Endoscopy(ASGE)grade of procedural complexity.There were no patients with sphincter of Oddi dysfunction.Ampullary biopsies suggested a diagnosis in 75.9% of the procedures including 12 adenomas,5 adenocarcinomas and 1 intraductal papillary mucinous neoplasm.Including major and minor complications,the overall complication rate with biopsy(9.3%)was equivalent to the complication rate in the control group without ampullary biopsy(9.3%,P>0.99).The incidence of post-procedure pancreatitis was not significantly different between the two groups(5.6% vs 3.7%,P=0.6).Age and pancreatic duct manipulation,but not ampullary biopsy,were associated with complications on multivariate analysis in the study population.Conclusions:Ampullary biopsy performed during ERCP had a high diagnostic yield and was not associated with an increased rate of post-procedure complications or pancreatitis when compared with ERCP alone.