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  • Title: Does general anesthesia increase the diagnostic yield of endoscopic ultrasound-guided fine needle aspiration of pancreatic masses?
    Author: Ootaki C, Stevens T, Vargo J, You J, Shiba A, Foss J, Borkowski R, Maurer W.
    Journal: Anesthesiology; 2012 Nov; 117(5):1044-50. PubMed ID: 23042221.
    Abstract:
    BACKGROUND: : Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of the pancreas has become the preferred method for tissue diagnosis for pancreatic solid masses. The yield of EUS-FNA in this setting is influenced by multiple factors. We hypothesized that general anesthesia (GA) may improve EUS-FNA yield by improving patient cooperation and stillness during the procedure. Our objective was to assess the association between the sedation method employed and the diagnostic yield of EUS-FNA. METHODS: : A retrospective cohort study was conducted involving consecutive patients who received EUS-FNA for diagnosis of a solid pancreatic mass at the Cleveland Clinic (Cleveland, OH) gastrointestinal endoscopy units from 2007 to 2009. We compared the diagnostic yield of EUS-FNA between patients receiving GA provided by an anesthesiologist (GA group) and patients receiving conscious sedation (CS) provided by a qualified registered nurse (CS group). RESULTS: : Of 371 patients, a cytological diagnosis was obtained in 73/88 patients (83%) in the GA group and 206/283 patients (73%) in the CS group. Anesthesiologist-delivered GA was associated with an increased odds of having a successful diagnosis as compared with CS (adjusted odds ratio [95% CI]: 2.56 [1.27-5.17], P = 0.01). However, the incidence of complication during or after the procedure was not different between the groups (P > 0.99). CONCLUSIONS: : Anesthesiologist-delivered GA was associated with a significantly higher diagnostic yield of EUS-FNA. GA should be considered a preferred sedation method for EUS-FNA of a solid pancreatic mass.
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