Comments on: “Fine-needle aspiration of pancreatic cystic lesions: a randomized study with long-term follow-up comparing standard and flexible needles”

We read with great interest the study by Al-Haddad et al. entitled, “Fine-needle aspiration of pancreatic cystic lesions: A randomized study comparing standard and flexible needles with long-term follow-up” [1]. We congratulate the authors as this is the largest prospective international multicenter study comparing 19G and 22G needles for the evaluation of pancreatic cystic lesions (PCLs).

In a prior meta-analysis of endoscopic ultrasound (EUS) guided-fine needle aspiration of PCLs, the pooled incidence of post-procedure acute pancreatitis was 0.92 %. However, a subgroup analysis involving only 19G needles revealed an increased risk at 1.63 % [2].

In regard to the use of novel endoscopic techniques requiring a 19G needle, the addition of EUS-guided needle-based confocal endomicroscopy (nCLE) and EUS-guided through-the-needle microbiopsy forceps (TTNB) has revealed a higher risk of acute pancreatitis. In the two largest prospective studies evaluating EUS-nCLE, the risk of acute pancreatitis ranged from 1.5 % to 3.5 % [3] [4]. During TTNB, the risk of post-procedure acute pancreatitis was 3.9 % in a large meta-analysis [5]; however, a more recent single-center large prospective study revealed a rate of 8.9 %, including one patient with acute pancreatitis-related mortality [6].

In the study of Al-Haddad et al., the authors report acute pancreatitis as being a serious adverse event in 1 % of patients (n = 3). However, they do not specify the type of needle associated with the adverse outcome of acute pancreatitis or whether there was a difference between the 19G and 22G needles. We believe it is of great relevance to emphasize any difference between needle diameter and risk of acute pancreatitis, if this exists. If there was an absence of risk of acute pancreatitis associated with the 19G needle, it may perhaps be that the longer “needle-time” within the cyst in EUS-nCLE or the intervention of microbiopsy in EUS-TTNB contributes to the increased risk of acute pancreatitis rather than the needle diameter.

Publikationsverlauf

Artikel online veröffentlicht:
26. August 2021

• References

• 1 Al-Haddad M, Wallace MB, Brugge W. et al. Fine-needle aspiration of pancreatic cystic lesions: A randomized study comparing standard and flexible needles with long-term follow-up. Endoscopy 2020; DOI: 10.1055/a-1311-9927.
• 2 Zhu H, Jiang F, Zhu J. et al. Assessment of morbidity and mortality associated with endoscopic ultrasound-guided fine-needle aspiration for pancreatic cystic lesions: A systematic review and meta-analysis. Dig Endosc 2017; 29: 667-675
• 3 Krishna SG, Hart PA, Malli A. et al. Endoscopic ultrasound-guided confocal laser endomicroscopy increases accuracy of differentiation of pancreatic cystic lesions. Clin Gastroenterol Hepatol 2020; 18: 432-440 e436
• 4 Napoleon B, Palazzo M, Lemaistre AI. et al. Needle-based confocal laser endomicroscopy of pancreatic cystic lesions: a prospective multicenter validation study in patients with definite diagnosis. Endoscopy 2019; 51: 825-835
• 5 McCarty T, Rustagi T. Endoscopic ultrasound-guided through-the-needle microforceps biopsy improves diagnostic yield for pancreatic cystic lesions: a systematic review and meta-analysis. Endosc Int Open 2020; 8: E1280-1290
• 6 Kovacevic B, Klausen P, Rift CV. et al. Clinical impact of endoscopic ultrasound-guided through-the-needle microbiopsy in patients with pancreatic cysts. Endoscopy 2021; 53: 44-52