D0430 - Anesthesia Care Provider Sedation (ACPS) Is Superior to Conscious Sedation (CS) for Successful Diagnostic Tissue Acquisition in Endoscopic Ultrasound Fine Needle Aspiration and/or Biopsy (EUS FNA/B)
Loma Linda University Medical Center Loma Linda, CA
Award: Presidential Poster Award
Sneha Shaha, DO, Yinglin Gao, DO, Jiahao Peng, MD, MPH, Kendrick Che, DO, John J. Kim, MD, Wasseem Skef, MD Loma Linda University Medical Center, Loma Linda, CA
Introduction: EUS-FNA/B is frequently used for diagnosis of suspicious intestinal, subepithelial, and extraintestinal lesions. Our study aimed to evaluate the role of sedation in the diagnostic yield of EUS-FNA/B of suspicious lesions in the mediastinum, abdomen and pelvis. Given frequent use and experience of CS with diagnostic EUS at our institution, we hypothesized that the diagnostic yield of EUS-FNA/B would be equivalent for both sedation groups.
Methods: A retrospective, single-center, cohort study was conducted including patients aged >18 years old who received EUS-FNA/B at our institution from 9/2018 – 5/2021 for further evaluation of suspicious lesions. Relevant baseline variables were collected for both groups. The primary endpoint was EUS diagnostic yield of neoplastic lesions. Successful cytologic diagnosis was defined by positive or suspicious results. Unsuccessful cytological results were defined by unsatisfactory, indeterminate, or false negative results. Secondary endpoint was adverse events (AEs). AEs were recorded for EUS only (EUS/ERCP patients were excluded from AE tally due to possible confounding). Baseline statistical comparison was done using the Chi-square test and Wilcoxon two sample tests. Univariate and multivariate logistic regression analysis was conducted to further evaluate primary and secondary outcomes. All statistical analyses were performed utilizing SAS Software (version 9.4; SAS Institute Inc. Cary, NC, USA).
Results: 369 patients met initial inclusion criteria. 67 cases with confirmed or suspected benign lesions were eliminated from analysis. Successful FNA/B was present in 146/196 (74.5%) of patients in the ACPS group and 66/106 (62.3%) in the CS group, (p = 0.0274). Upon multivariate logistic regression controlling for lesion size, location, needle size, number of passes, and presence of ROSE, the difference in diagnostic yield between the CS and GA groups remained statistically significant (adjusted odds ratio [95% CI]: 0.558 [0.315 - 0.987], P = 0.0451) (Table 1). Adverse events (AEs) occurred more frequently in the ACPS group. This difference was sustained on multivariate analysis controlling for BMI, age, and ASA class.
Discussion: ACPS is associated with improved diagnostic yield when performing EUS-FNA/B for suspicious lesions in the mediastinum, abdomen, and pelvis. AEs occur more frequently in ACPS albeit most AEs are mild and associated with general anesthesia.
Demographics
Type of sedation
Anesthesia
Conscious Sedation
N(number of patients)
%
N
%
P value
Gender
0.07
Male
110
47.21
51
37.5
Female
123
52.79
85
62.5
ASA Class
< 0.001
1
5
2.15
8
5.88
2
45
19.31
63
46.32
3
169
72.53
65
47.79
4
14
6.01
.
.
Location
0.001
Thoracic
1
0.43
1
0.74
Abdominal (non-pancreas)
26
11.16
22
16.18
Pelvic
3
1.29
2
1.47
pancreas ampulla/uncinate/head
130
55.79
42
30.88
neck/body/tail pancreas
50
21.46
46
33.82
SEL
22
9.44
22
16.18
Cytologic Result
0.007
Unsatisfactory specimen
14
6.01
22
16.18
Negative for malignancy
43
18.45
33
24.26
Atypical/Indeterminate
30
12.88
15
11.03
Suspicious for malignancy
10
4.29
3
2.21
Positive for malignancy
136
58.37
63
46.32
FNB
< 0.001
N
140
60.09
115
84.56
Y
93
39.91
21
15.44
Univariate and Multivariate logistic regression analysis
Univariate logistic regression (Crude effect)
Unit
OR
95% Confidence Limits
p-Value
Type of sedation (CS vs Anesthesia)
1
0.565
0.34
0.938
0.0274
Adjusted Effect
Unit
OR
95% Confidence Limits
Column1
p-Value
Type of sedation CS vs Anesthesia
1
0.558
0.315
0.987
0.0451
Location Others vs (pancreas ampulla/uncinate/head)
1
0.46
0.2
1.063
0.0691
Number of needle passed
1
1.473
1.191
1.822
0.0004
Categories of Adverse Events
Type of Sedation
CS
Anesthesia
Severity
GA
MAC
Mild
3
14
2
Moderate
1
5
0
Severe
0
3
0
Fatal
0
0
0
Total
4
22
2
**Total of 28 adverse events
Table: Table 1. Descriptive Analysis of demographics, Univariate/Multivariate logistic regression analysis, and Adverse Events
Disclosures:
Sneha Shaha indicated no relevant financial relationships.
Yinglin Gao indicated no relevant financial relationships.
Jiahao Peng indicated no relevant financial relationships.
Kendrick Che indicated no relevant financial relationships.
John Kim indicated no relevant financial relationships.
Wasseem Skef indicated no relevant financial relationships.
Sneha Shaha, DO, Yinglin Gao, DO, Jiahao Peng, MD, MPH, Kendrick Che, DO, John J. Kim, MD, Wasseem Skef, MD. D0430 - Anesthesia Care Provider Sedation (ACPS) Is Superior to Conscious Sedation (CS) for Successful Diagnostic Tissue Acquisition in Endoscopic Ultrasound Fine Needle Aspiration and/or Biopsy (EUS FNA/B), ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
