title: Comparison of the outcomes of endoscopic ultrasound based on community hospital versus tertiary academic center settings.
abstract: OBJECTIVE
  Endoscopic ultrasound (EUS) is an established tool in the management of gastrointestinal diseases. The majority of EUS procedures are performed in tertiary care hospitals but the technology has also disseminated to community hospitals. The data from community hospitals are limited and there are no published studies comparing EUS-fine needle aspiration (FNA) outcomes in community versus tertiary settings. Our objective is to compare EUS procedures performed in these two separate settings.
  
  
  METHODS
  EUS procedures performed for pancreatobiliary indications in an academic tertiary care hospital and a community hospital were retrospectively reviewed and compared. The patient demographics, procedure time, procedure indications, FNA performed, pass counts, needle size, rapid onsite evaluation (ROSE) and final cytological diagnosis were compared between the two centers. Cytological diagnosis was categorized as satisfactory and unsatisfactory samples.
  
  
  RESULTS
  There was no significant difference in patient age, gender, indications, procedure time, FNA performed, needle size, or pass counts between the tertiary hospital (n = 361) and community hospital (n = 119). ROSE was a significant determinant factor for adequacy of sample. There was a positive linear relationship between adequacy of the sample and number of pass counts. After performing a logistic regression and adjusting for target site, the overall odds of having an unsatisfactory specimen were not significantly different at the two centers (OR 0.51, CI 0.23-1.17, p = 0.11). Percentages of unsatisfactory samples were not significantly different at the two centers for solid lesions (7.4 vs. 3.1%, p = 0.33), cysts (33.3 vs. 23.8%, p = 0.31,) or lymph nodes (25.0 vs. 0%, p = 0.063).
  
  
  CONCLUSIONS
  Cytological yield of EUS-FNA in a community hospital is similar to that of a tertiary hospital. Community hospitals can provide EUS services with reasonable success.
authors.affiliation: Division of Gastroenterology, West Penn Allegheny Health System, 320 East North Avenue, Pittsburgh, PA, 15212, USA, shail121@gmail.com.
authors.forename: Shailendra
authors.initials: S
authors.lastname: Singh
authors.forename: Treta
authors.initials: T
authors.lastname: Purohit
authors.forename: Elie
authors.initials: E
authors.lastname: Aoun
authors.forename: Yatindra
authors.initials: Y
authors.lastname: Patel
authors.forename: Neil
authors.initials: N
authors.lastname: Carleton
authors.forename: Marcia
authors.initials: M
authors.lastname: Mitre
authors.forename: Suzanne
authors.initials: S
authors.lastname: Morrissey
authors.forename: Manish
authors.initials: M
authors.lastname: Dhawan
authors.forename: Shyam
authors.initials: S
authors.lastname: Thakkar
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D001660:Biliary Tract Diseases / Q000175:diagnosis*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000592:standards; D016145:Endoscopy, Digestive System / Q000592:standards; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000175:diagnosis*; D012189:Retrospective Studies; D016896:Treatment Outcome