title: High risk of acute pancreatitis after endoscopic ultrasound-guided fine needle aspiration of side branch intraductal papillary mucinous neoplasms.
abstract: OBJECTIVE
  Data on the risk of acute pancreatitis following endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic cystic lesions are limited. The aim of our study was to evaluate the frequency of acute pancreatitis after EUS-FNA of pancreatic cysts and solid lesions, and determine whether there was a difference in pancreatitis risk in patients with side branch intraductal papillary mucinous neoplasms (SB-IPMN).
  
  
  METHODS
  A retrospective review of patients who underwent EUS-FNA of pancreatic cysts and solid lesions was performed. The primary outcome measure was development of acute pancreatitis after EUS-FNA. Factors associated with acute pancreatitis were examined by statistical analysis to determine independent predictors of acute pancreatitis. Statistical significance was determined at a P ≤ 0.05.
  
  
  RESULTS
  We identified 186 patients with pancreatic cystic lesions and 557 with solid lesions in which EUS-FNA was performed. The median size of the cysts was 19 mm (range: 10-66 mm). There were 37 IPMNs, 33 mucinous cystic neoplasms, 58 serous cysts and 46 pseudocysts and 12 solid-cystic ductal carcinomas. The majority of patients (75%) with solid lesions were diagnosed with adenocarcinoma. Patients with pancreatic cysts had a statistically greater frequency of developing pancreatitis after EUS-FNA when compared to those with solid lesions (2.6% vs. 0.36% respectively; P = 0.13). In patients with cysts, there were no statistically significant differences between the two groups (with and without pancreatitis) with regard to a cyst location, size of the cyst, and number of needle passes or trainee involvement. Patients with SB-IPMN had a statistically higher frequency of pancreatitis after EUS-FNA compared to those with other cyst types (8% vs. 1.3% respectively; odds ratio = 6.4, 95% confidence intervals = 1.0-40.3, P = 0.05).
  
  
  CONCLUSIONS
  Patients with SB-IPMN are at a higher risk of developing acute pancreatitis after a EUS-FNA. Alternative means of diagnosis such as magnetic resonance cholangiopancreatogram might be necessary to avoid risk of EUS-FNA.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Siddiqui
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Haroon
authors.initials: H
authors.lastname: Shahid
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Apeksha
authors.initials: A
authors.lastname: Shah
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Tanvi
authors.initials: T
authors.lastname: Khurana
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: William
authors.initials: W
authors.lastname: Huntington
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Saad S
authors.initials: SS
authors.lastname: Ghumman
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Loren
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Kowalski
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Sobia
authors.initials: S
authors.lastname: Laique
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Umar
authors.initials: U
authors.lastname: Hayat
authors.affiliation: Division of Gastroenterology and Hepatology, Northeast Alabama Regional Medical Center, Anniston, AL, USA.
authors.forename: Mohamad A
authors.initials: MA
authors.lastname: Eloubeidi
keywords: Acute pancreatitis; endosonography; fine-needle aspiration; intraductal papillary; mucinous neoplasm