title: The impact of prior biliary stenting on the accuracy and complication rate of endoscopic ultrasound fine-needle aspiration for diagnosing pancreatic adenocarcinoma.
abstract: OBJECTIVE
  Our aim was to determine whether the presence of a biliary stent during endoscopic ultrasound fine-needle aspiration (EUS-FNA) affects diagnosis and complication rates.
  
  
  METHODS
  Retrospective analysis was performed of 268 patients with pancreatic head or neck adenocarcinoma who underwent EUS-FNA at our academic medical center between 2000 and 2009. Endoscopic ultrasound fine-needle aspiration and endoscopic retrograde cholangiopancreatography reports, cytology results, and physicians' notes were reviewed.
  
  
  RESULTS
  A total of 170 patients without stents, 87 patients with stents placed more than 1 day before EUS, and 11 patients with stents placed less than 1 day before EUS were identified. In patients without stents, the tissue diagnosis rate via EUS-FNA was 92.4% compared with a rate of 88.5% for those with stents placed more than 1 day before EUS-FNA (P=0.36). However, the patients with stents placed immediately before EUS-FNA were more likely to have indeterminate results from the EUS-FNA than the other patients were (P=0.008). Complication rates were the same among the groups.
  
  
  CONCLUSIONS
  Pre-EUS stenting of biliary obstruction due to pancreatic adenocarcinoma does not influence the rate of tissue diagnosis if performed more than 1 day before EUS-FNA. Lack of immediate EUS access should not preclude stent placement in appropriate patients with malignant biliary obstruction who will undergo EUS-FNA.
authors.affiliation: Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Fisher
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Gordon
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Gardner
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D000368:Aged; D044963:Biopsy, Fine-Needle; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000628:therapy*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D015607:Stents