Effectiveness of combined endoscopic ultrasound-guided fine-needle aspiration biopsy and stenting in patients with suspected pancreatic cancer.
BACKGROUND
Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) can be coupled with endoscopic retrograde cholangiopancreatography in the same setting when biliary and/or duodenal stenting are required.


OBJECTIVE
Our aim was to examine the effectiveness of EUS-FNA combined with stenting during the same session in patients with pancreatic cancer.


METHODS
Consecutive patients referred for EUS-FNA of a pancreatic mass with symptoms of biliary (±upper digestive) obstruction were included. Consecutive patients undergoing biliary and/or duodenal stenting without EUS-FNA during the same period were used as controls. Procedure-related complications were the primary outcome measure. Duration of the procedure, ability to achieve biliary/duodenal stenting, the yield of EUS-FNA, and clinical outcomes were evaluated.


RESULTS
A total of 122 patients underwent combined EUS-FNA and stenting and 68 underwent stenting alone (control group). In the combined group, histological proof of cancer was obtained in 88.52% at first EUS-FNA and 95.08% after a second EUS-FNA. Biliary stent placement was successful in 97.5 and 98% in the combined and the control groups, respectively. There was no statistical difference between the groups for length of stay after endoscopy and for procedure-related mortality and morbidity within 30 days. The median time from endoscopy to chemotherapy in the combined group was 12 days.


CONCLUSIONS
Combined EUS-FNA and biliary and/or duodenal stenting is feasible in almost all patients with suspected pancreatic cancer, with no additional hazard and a high histological yield.
Department of aGastroenterology, Hopital Cochin, Paris, France.
Marine
M
Camus
Isabelle
I
Trouilloud
Ana L
AL
Villacis
Luigi
L
Mangialavori
Jean-Christophe
JC
Duchmann
Marianne
M
Gaudric
Gilles
G
Roseau
Benoit
B
Terris
Emmanuel
E
Mitry
Stanislas
S
Chaussade
Frederic
F
Prat
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation*; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D004380:Duodenal Obstruction / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome