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  • Title: Impact of biliary stents on EUS-guided FNA of pancreatic mass lesions.
    Author: Ranney N, Phadnis M, Trevino J, Ramesh J, Wilcox CM, Varadarajulu S.
    Journal: Gastrointest Endosc; 2012 Jul; 76(1):76-83. PubMed ID: 22726468.
    Abstract:
    BACKGROUND: Few studies have evaluated the impact of biliary stents on EUS-guided FNA. AIM: To compare diagnostic yield of EUS-FNA in patients with or without biliary stents. DESIGN: Retrospective study. SETTING: Tertiary referral center. PATIENTS: Patients with obstructive jaundice secondary to solid pancreatic mass lesions who underwent EUS-FNA over 5 years. MAIN OUTCOME MEASURES: The primary objective was to compare the diagnostic accuracy of EUS-FNA in patients with or without biliary stents and between patients with plastic stents or self-expandable metal stents (SEMSs). Secondary objectives were to assess the technical difficulty of EUS-FNA by comparing the number of passes required to establish diagnosis and to identify predictors of a false-negative diagnosis. RESULTS: Of 214 patients who underwent EUS-FNA, 150 (70%) had biliary stents and 64 (30%) had no stents in place. Of 150 patients with biliary stents, 105 (70%) were plastic and 45 (30%) were SEMSs. At EUS-FNA, the diagnosis was pancreatic cancer in 155 (72%), chronic pancreatitis in 17 (8%), other cancer in 31 (14%), and indeterminate in 11 (5%). There was no difference in rates of diagnostic accuracy between patients with or without stents (93.7% vs 95.3%; P = .73) and between plastic or SEMSs (95.2% vs 95.5%, P = .99), respectively. Median number of passes to diagnosis was not significantly different between patients with or without stents (2 [interquartile ratio range (IQR) = 1-3] vs 2 [IQR = 1-4]; P = .066) and between plastic or SEMS (2.5 [IQR = 1-4] vs 2 [IQR = 1-4], P = .69), respectively. On univariate analysis, EUS-FNA results were false-negative in patients with large pancreatic masses (>3 cm vs <3 cm, 9.35% vs 0.93%, P = .005) that required more FNA passes (<2 vs >2 passes, 0% vs 11.8%, P < .0001). LIMITATIONS: Retrospective study. CONCLUSIONS: The presence or absence of a biliary stent, whether plastic or metal, does not have an impact on the diagnostic yield or technical difficulty of EUS-FNA.
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