Endoscopy 2021; 53(01): 44-52
DOI: 10.1055/a-1214-6043
Original article

Clinical impact of endoscopic ultrasound-guided through-the-needle microbiopsy in patients with pancreatic cysts

Bojan Kovacevic
1  Gastroenterology Unit, Division of Endoscopy, Herlev Hospital, Herlev, Denmark
,
Pia Klausen
1  Gastroenterology Unit, Division of Endoscopy, Herlev Hospital, Herlev, Denmark
,
Charlotte Vestrup Rift
2  Department of Pathology, Rigshospitalet, Copenhagen, Denmark
,
Anders Toxværd
3  Department of Pathology, Herlev Hospital, Herlev, Denmark
,
Hanne Grossjohann
4  Department of Gastrointestinal Surgery, Rigshospitalet, Copenhagen, Denmark
,
John Gásdal Karstensen
5  Gastroenterology Unit, Pancreatitis Centre East, Hvidovre Hospital, Hvidovre, Denmark
6  Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
,
Lene Brink
1  Gastroenterology Unit, Division of Endoscopy, Herlev Hospital, Herlev, Denmark
,
Hazem Hassan
1  Gastroenterology Unit, Division of Endoscopy, Herlev Hospital, Herlev, Denmark
,
Evangelos Kalaitzakis
1  Gastroenterology Unit, Division of Endoscopy, Herlev Hospital, Herlev, Denmark
,
Jan Storkholm
4  Department of Gastrointestinal Surgery, Rigshospitalet, Copenhagen, Denmark
,
Carsten Palnæs Hansen
4  Department of Gastrointestinal Surgery, Rigshospitalet, Copenhagen, Denmark
,
Jane Preuss Hasselby
2  Department of Pathology, Rigshospitalet, Copenhagen, Denmark
,
Peter Vilmann
1  Gastroenterology Unit, Division of Endoscopy, Herlev Hospital, Herlev, Denmark
6  Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
› Author Affiliations
Trial Registration: ClinicalTrials.gov Registration number (trial ID): NCT03578445 Type of study: prospective study

Abstract

Background The limited data on the utility of endoscopic ultrasound (EUS)-guided through-the-needle biopsies (TTNBs) in patients with pancreatic cystic lesions (PCLs) originate mainly from retrospective studies. Our aim was to determine the clinical impact of TTNBs, their added diagnostic value, and the adverse event rate in a prospective setting.

Methods This was a prospective, single-center, open-label controlled study. Between February 2018 and August 2019, consecutive patients presenting with a PCL of 15 mm or more and referred for EUS were included. Primary outcome was a change in clinical management of PCLs following TTNB compared with cross-sectional imaging and cytology. Adverse events were defined according to the ASGE lexicon.

Results 101 patients were included. TTNBs led to a change in clinical management in 11.9 % of cases (n = 12). Of these, 10 had serous cysts and surveillance was discontinued, while one of the remaining two cases underwent surgery following diagnosis of a mucinous cystic neoplasm. The diagnostic yield of TTNBs for a specific cyst diagnosis was higher compared with FNA cytology (69.3 % vs. 20.8 %, respectively; P < 0.001). The adverse event rate was 9.9 % (n = 10; 95 % confidence interval 5.4 % – 17.3 %), with the most common event being acute pancreatitis (n = 9). Four of the observed adverse events were severe, including one fatal outcome.

Conclusions TTNBs resulted in a change of clinical management in about one in every 10 patients; however, the associated adverse event risk was substantial. Further studies are warranted to elucidate in which subgroups of patients the clinical benefit outweighs the risks.

Supplementary material



Publication History

Received: 27 February 2020

Accepted: 04 June 2020

Publication Date:
21 July 2020 (online)

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