title: Does general anesthesia increase the diagnostic yield of endoscopic ultrasound-guided fine needle aspiration of pancreatic masses?
abstract: BACKGROUND
  : Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of the pancreas has become the preferred method for tissue diagnosis for pancreatic solid masses. The yield of EUS-FNA in this setting is influenced by multiple factors. We hypothesized that general anesthesia (GA) may improve EUS-FNA yield by improving patient cooperation and stillness during the procedure. Our objective was to assess the association between the sedation method employed and the diagnostic yield of EUS-FNA.
  
  
  METHODS
  : A retrospective cohort study was conducted involving consecutive patients who received EUS-FNA for diagnosis of a solid pancreatic mass at the Cleveland Clinic (Cleveland, OH) gastrointestinal endoscopy units from 2007 to 2009. We compared the diagnostic yield of EUS-FNA between patients receiving GA provided by an anesthesiologist (GA group) and patients receiving conscious sedation (CS) provided by a qualified registered nurse (CS group).
  
  
  RESULTS
  : Of 371 patients, a cytological diagnosis was obtained in 73/88 patients (83%) in the GA group and 206/283 patients (73%) in the CS group. Anesthesiologist-delivered GA was associated with an increased odds of having a successful diagnosis as compared with CS (adjusted odds ratio [95% CI]: 2.56 [1.27-5.17], P = 0.01). However, the incidence of complication during or after the procedure was not different between the groups (P > 0.99).
  
  
  CONCLUSIONS
  : Anesthesiologist-delivered GA was associated with a significantly higher diagnostic yield of EUS-FNA. GA should be considered a preferred sedation method for EUS-FNA of a solid pancreatic mass.
authors.affiliation: Anesthesiology Institute. cootaki@wfubmc.edu
authors.forename: Chiyo
authors.initials: C
authors.lastname: Ootaki
authors.forename: Tyler
authors.initials: T
authors.lastname: Stevens
authors.forename: John
authors.initials: J
authors.lastname: Vargo
authors.forename: Jing
authors.initials: J
authors.lastname: You
authors.forename: Ayako
authors.initials: A
authors.lastname: Shiba
authors.forename: Joseph
authors.initials: J
authors.lastname: Foss
authors.forename: Raymond
authors.initials: R
authors.lastname: Borkowski
authors.forename: Walter
authors.initials: W
authors.lastname: Maurer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000379:methods*; D015331:Cohort Studies; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies