Impact of biliary stents on EUS-guided FNA of pancreatic mass lesions.
BACKGROUND
Few studies have evaluated the impact of biliary stents on EUS-guided FNA.


OBJECTIVE
To compare diagnostic yield of EUS-FNA in patients with or without biliary stents.


METHODS
Retrospective study.


METHODS
Tertiary referral center.


METHODS
Patients with obstructive jaundice secondary to solid pancreatic mass lesions who underwent EUS-FNA over 5 years.


METHODS
The primary objective was to compare the diagnostic accuracy of EUS-FNA in patients with or without biliary stents and between patients with plastic stents or self-expandable metal stents (SEMSs). Secondary objectives were to assess the technical difficulty of EUS-FNA by comparing the number of passes required to establish diagnosis and to identify predictors of a false-negative diagnosis.


RESULTS
Of 214 patients who underwent EUS-FNA, 150 (70%) had biliary stents and 64 (30%) had no stents in place. Of 150 patients with biliary stents, 105 (70%) were plastic and 45 (30%) were SEMSs. At EUS-FNA, the diagnosis was pancreatic cancer in 155 (72%), chronic pancreatitis in 17 (8%), other cancer in 31 (14%), and indeterminate in 11 (5%). There was no difference in rates of diagnostic accuracy between patients with or without stents (93.7% vs 95.3%; P = .73) and between plastic or SEMSs (95.2% vs 95.5%, P = .99), respectively. Median number of passes to diagnosis was not significantly different between patients with or without stents (2 [interquartile ratio range (IQR) = 1-3] vs 2 [IQR = 1-4]; P = .066) and between plastic or SEMS (2.5 [IQR = 1-4] vs 2 [IQR = 1-4], P = .69), respectively. On univariate analysis, EUS-FNA results were false-negative in patients with large pancreatic masses (>3 cm vs <3 cm, 9.35% vs 0.93%, P = .005) that required more FNA passes (<2 vs >2 passes, 0% vs 11.8%, P < .0001).


CONCLUSIONS
Retrospective study.


CONCLUSIONS
The presence or absence of a biliary stent, whether plastic or metal, does not have an impact on the diagnostic yield or technical difficulty of EUS-FNA.
Division of Gastroenterology-Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Nathaniel
N
Ranney
Milind
M
Phadnis
Jessica
J
Trevino
Jayapal
J
Ramesh
C Mel
CM
Wilcox
Shyam
S
Varadarajulu
D000230:Adenocarcinoma / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D016009:Chi-Square Distribution; D019160:Endosonography; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D050500:Pancreatitis, Chronic / Q000175:diagnosis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015607:Stents; D018084:Ultrasonography, Interventional