D0436 - Impact of Biliary Stents on Diagnostic Yield of Endoscopic Ultrasound-Guided Tissue Acquisition of Solid Pancreatic Head Lesions: A Systematic Review and Meta-Analysis

Daryl Ramai, MD, MSc¹, Antonio Facciorusso, MD, PhD², Paraskevas Gkolfakis, MD³, Saurabh Chandan, MD⁴, Andrea Lisotti, MD⁵, Maria Conti Bellocchi, MD⁶, Ioannis Papanikolaou, MD⁷, Benedetto Mangiavillano, MD⁸, Konstantinos Triantafyllo, MD⁷, Babu P. Mohan, MD, MS⁹, Elena Manthopoulou, MD¹⁰, Ruxandra Mare, MD¹¹, Pietro Fusaroli, MD⁵, Stefano Crinò, MD^6
1University of Utah, Salt Lake City, UT; ²University of Foggia, Foggia, Puglia, Italy; ³Université libre de bruxelles, Brussels, Brussels Hoofdstedelijk Gewest, Belgium; ⁴CHI Health Creighton School of Medicine, Omaha, NE; ⁵University of Bologna, Bologna, Emilia-Romagna, Italy; ⁶University Hospital of Verona, Verona, Veneto, Italy; ⁷University of Athens, Athens, Akhaia, Greece; ⁸Humanitas Mater Domini, Castellanza, Lombardia, Italy; ⁹University of Utah School of Medicine, Salt Lake City, UT; ¹⁰Humanitas Mater Domini, Timișoara, Timis, Romania; ¹¹University of Medicine and Pharmacy, Timișoara, Timis, Romania

Introduction: There is scarce evidence on the impact of biliary stents on endoscopic ultrasound (EUS) fine-needle biopsy (FNB) or fine-needle aspiration (FNA) of pancreatic head masses. Aim of this meta-analysis was to compare the diagnostic performance of EUS-guided tissue sampling in patients with or without biliary stents.



Methods: We searched PubMed/Medline and Embase databases through March 2022 and identified 7 studies (2458 patients). Primary outcome was diagnostic accuracy. Secondary outcomes were sample adequacy, diagnostic sensitivity, specificity, and number of needle passes. We performed pairwise meta-analysis through a random effects model and expressed results as odds ratio (OR) or mean difference along with 95% confidence interval (CI).



Results: Pooled accuracy was 85.4% (95% CI 78.8%-91.9%) and 88.1% (83.3%-92.9%) in patients with and without stent, respectively with no significant difference between the two approaches (OR 0.74, 95% CI 0.53-1.02; p=0.07). No difference in patients with plastic stent was observed (OR 0.89, 0.51-1.54; p=0.67) whereas a significant difference was observed in patients with metal stent (OR 0.54, 0.17-0.97; p=0.05). Diagnostic accuracy with EUS-FNB was significantly lower in patients with biliary stents (OR 0.64, 0.43-0.95; p=0.03) whereas no difference was observed with FNA. No difference in terms of sample adequacy was observed between the two groups (OR 1.06, 0.67-1.67; p=0.81). Diagnostic sensitivity was significantly lower in patients with biliary stent (OR 0.59, 0.44-0.80; p< 0.001) and the number of needle passes was not significantly different between the two groups (mean difference -0.09, -0.30 to 0.11; p=0.38).

Discussion: The presence of a metal stent negatively impacts on diagnostic yield of EUS tissue sampling for pancreatic head lesions, whereas no difference seems to be observed with plastic stents. Therefore, in jaundiced patients, EUS tissue sampling should precede ERCP, especially when metal stents are used.



Disclosures:


Daryl Ramai, MD, MSc¹, Antonio Facciorusso, MD, PhD², Paraskevas Gkolfakis, MD³, Saurabh Chandan, MD⁴, Andrea Lisotti, MD⁵, Maria Conti Bellocchi, MD⁶, Ioannis Papanikolaou, MD⁷, Benedetto Mangiavillano, MD⁸, Konstantinos Triantafyllo, MD⁷, Babu P. Mohan, MD, MS⁹, Elena Manthopoulou, MD¹⁰, Ruxandra Mare, MD¹¹, Pietro Fusaroli, MD⁵, Stefano Crinò, MD⁶. D0436 - Impact of Biliary Stents on Diagnostic Yield of Endoscopic Ultrasound-Guided Tissue Acquisition of Solid Pancreatic Head Lesions: A Systematic Review and Meta-Analysis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.