Subscribe to RSS
DOI: 10.1055/a-1534-2558
Pancreaticobiliary endoscopic ultrasound in England 2007 to 2016: Changing practice and outcomes
Abstract
Background and study aims Population-level data on the outcomes of pancreaticobiliary endoscopic ultrasound (PB-EUS) are limited. We examined national PB-EUS and fine-needle aspiration (FNA) activity, its relation to pancreatic cancer therapy, associated mortality and adverse events.
Patients and methods Adults undergoing PB-EUS in England from 2007–2016 were identified in Hospital Episode Statistics. A pancreatic cancer cohort diagnosed within 6 months of PB-EUS were studied separately. Multivariable logistic regression models examined associations with 30-day mortality and therapies for pancreatic cancer.
Results 79,269 PB-EUS in 68,908 subjects were identified. Annual numbers increased from 2,874 (28 % FNA) to 12,752 (35 % FNA) from 2007 to 2016. 8,840 subjects (13 %) were diagnosed with pancreatic cancer. Sedation related adverse events were coded in 0.5 % and emergency admission with acute pancreatitis in 0.2 % within 48 hours of PB-EUS. 1.5 % of subjects died within 30 days of PB-EUS. Factors associated with 30-day mortality included increasing age (odds ratio 1.03 [95 % CI 1.03–1.04]); male sex (1.38 [1.24–1.56]); increasing comorbidity (1.49 [1.27–1.74]); EUS-FNA (2.26 [1.98–2.57]); pancreatic cancer (1.39 [1.19–1.62]); increasing deprivation (least deprived quintile 0.76 [0.62–0.93]) and lower provider PB-EUS volume (2.83 [2.15–3.73]). Factors associated with surgical resection in the pancreatic cancer cohort included lower provider PB-EUS volume (0.44 [0.26–0.74]) and the least deprived subjects (1.33 [1.12–1.57]). 33 % of pancreatic cancer subjects who underwent EUS, did not subsequently receive active cancer treatment.
Conclusions Lower provider PB-EUS volume was associated with higher 30-day mortality and reduced rates of both pancreatic cancer surgery and chemotherapy. These results suggest potential issues with case selection in lower-volume EUS providers.
Publication History
Received: 01 April 2021
Accepted: 14 June 2021
Article published online:
12 November 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Oppong K. Advancing the diagnostic and therapeutic role of EUS in pancreaticobiliary disease: Hopkins Lecture 2016. Frontline Gastroenterol 2017; 8: 115-118
- 2 De Lisi S, Giovannini M. Endoscopic ultrasonography: Transition towards the future of gastro-intestinal diseases. World J Gastroenterol 2016; 22: 1779-1786
- 3 Nayar MK, Paranandi B, Dawwas MF. et al. Comparison of the diagnostic performance of 2 core biopsy needles for EUS-guided tissue acquisition from solid pancreatic lesions. Gastrointest Endosc 2017; 85: 1017-1024
- 4 Hewitt MJ, McPhail MJW, Possamai L. et al. EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc 2012; 75: 319-331
- 5 Oppong KW, Dawwas MF, Charnley RM. et al. EUS and EUS-FNA diagnosis of suspected pancreatic cystic neoplasms: Is the sum of the parts greater than the CEA?. Pancreatology 2015; 15: 531-537
- 6 Cizginer S, Turner BG, Bilge AR. et al. Cyst fluid carcinoembryonic antigen is an accurate diagnostic marker of pancreatic mucinous cysts. Pancreas 2011; 40: 1024-1028
- 7 Thornton GD, McPhail MJW, Nayagam S. et al. Endoscopic ultrasound guided fine needle aspiration for the diagnosis of pancreatic cystic neoplasms: A meta-analysis. Pancreatology 2013; 13: 48-57
- 8 Wang K-X, Ben Q-W, Jin Z-D. et al. Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review. Gastrointest Endosc 2011; 73: 283-290
- 9 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
- 10 Ngamruengphong S, Swanson KM, Shah ND. et al. Preoperative endoscopic ultrasound-guided fine needle aspiration does not impair survival of patients with resected pancreatic cancer. Gut 2015; 64: 1105-1110
- 11 Ngamruengphong S, Li F, Zhou Y. et al. EUS and survival in patients with pancreatic cancer: a population-based study. Gastrointest Endosc 2010; 72: 78-83
- 12 Hospital Episode Statistics. http://www.hscic.gov.uk/hes
- 13 Index of Multiple Deprivation (IMD). 2007 https://data.gov.uk/dataset/bdc1e1a5-aaf3-4f5a-9988-82a11e341eb8/index-of-multiple-deprivation-imd-2007
- 14 Nuttall M, van der Meulen J, Emberton M. Charlson scores based on ICD-10 administrative data were valid in assessing comorbidity in patients undergoing urological cancer surgery. J Clin Epidemiol 2006; 59: 265-273
- 15 D’Souza SL, Holub JL, Pavic BT. et al. Multicenter evaluation of the utilization of endoscopic ultrasound. Dig Endosc 2016; 28: 738-743
- 16 James PD, Hegagi M, Antonova L. et al. Regional differences in use of endoscopic ultrasonography in Ontario: a population-based retrospective cohort study. CMAJ Open 2017; 5: 437-443
- 17 Pancreatic cancer incidence statistics. 2015 https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/pancreatic-cancer/incidence
- 18 Hébert-Magee S, Bae S, Varadarajulu S. et al. The presence of a cytopathologist increases the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration cytology for pancreatic adenocarcinoma: a meta-analysis. Cytopathology 2013; 24: 159-171
- 19 Puli SR, Bechtold ML, Eloubeidi MA. how good is eus-fna in diagnosing the correct etiology for a solid pancreatic mass? A meta-analysis and systematic review. . Gastrointest Endosc 2009; 69: 243
- 20 Polkowski M, Larghi A, Weynand B. et al. Learning, techniques, and complications of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline. Endoscopy 2012; 44: 190-206
- 21 Eloubeidi MA, Tamhane A, Lopes TL. et al. Cervical esophageal perforations at the time of endoscopic ultrasound: a prospective evaluation of frequency, outcomes, and patient management. Am J Gastroenterol 2009; 104: 53-56
- 22 Das A, Sivak Jr MV , Chak A. Cervical esophageal perforation during EUS: a national survey. Gastrointest Endosc 2001; 53: 599-602
- 23 Wiersema M, Vilmann P, Giovannini M. et al. Prospective multicenter evaluation of eus guided fine needle aspiration biopsy (FNA): Diagnostic accuracy and complication assessment. Gastrointest Endosc 1996; 43: 432
- 24 Mortensen MB, Fristrup C, Holm FS. et al. Prospective evaluation of patient tolerability, satisfaction with patient information, and complications in endoscopic ultrasonography. Endoscopy 2005; 37: 146-153
- 25 Al-Haddad M, Wallace M, Woodward T. et al. The safety of fine-needle aspiration guided by endoscopic ultrasound: a prospective study. Endoscopy 2007; 40: 204-208
- 26 Bournet B, Migueres I, Delacroix M. et al. Early morbidity of endoscopic ultrasound: 13 years’ experience at a referral center. Endoscopy 2006; 38: 349-354
- 27 Eloubeidi MA, Tamhane A, Varadarajulu S. et al. Frequency of major complications after EUS-guided FNA of solid pancreatic masses: a prospective evaluation. Gastrointest Endosc 2006; 63: 622-629
- 28 Eloubeidi MA, Gress FG, Savides TJ. et al. Acute pancreatitis after EUS-guided FNA of solid pancreatic masses: a pooled analysis from EUS centers in the United States. Gastrointest Endosc 2004; 60: 385-389
- 29 Gress F, Michael H, Gelrud D. et al. EUS-guided fine-needle aspiration of the pancreas: Evaluation of pancreatitis as a complication. Gastrointest Endosc 2002; 56: 864-867
- 30 Pancreatic cancer survival statistics. 2015 https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/pancreatic-cancer/survival
- 31 Oppong KW, Richardson DL, Charnley RM. et al. The development and evolution of a tertiary pancreaticobiliary endoscopic ultrasound service: lessons learned. Frontline Gastroenterol 2011; 2: 66-70
- 32 Survival for all stages of pancreatic cancer. https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer/survival
- 33 Public Health England. Seven things we learned from our latest cancer treatment data. 2018 https://publichealthmatters.blog.gov.uk/2018/07/17/seven-things-we-learned-from-our-latest-cancer-treatment-data/
- 34 Shapiro M, Chen Q, Huang Q. et al. Associations of socioeconomic variables with resection, stage, and survival in patients with early-stage pancreatic cancer. JAMA Surgery 2016; 151: 338-345
- 35 Health and Social Care Information Centre. The quality of nationally submitted health and social care data England, annual report, 2013, experimental statistics. https://digital.nhs.uk/data-and-information/publications/statistical/the-quality-of-nationally-submitted-health-and-social-care-data/the-quality-of-nationally-submitted-health-and-social-care-data-england-2013-second-annual-report-experimental-statistics