Needle-tract seeding (NTS) has been sporadically reported as complication of Endoscopic Ultrasound (EUS)-guided aspiration (FNA) in pancreatic adenocarcinoma (PDAC). However, the evidence of its treatment and outcome is sparse. Adhering to PRISMA guidelines, we conducted a systematic review of EUS-FNA NTS cases of PDAC and analyzed their management and outcome. Up to September 2022, the search query retrieved forty-five cases plus an unpublished case from our center, for a total of forty-six; 43.6% were male, with a mean age of 68.6 years. Thirty-four patients (87.1%) underwent an initial surgical resection, with only 44.1% and 5.9% undergoing adjuvant and neoadjuvant chemotherapy, respectively, and 5.9% undergoing both. The NTS nodule was mostly located in the posterior gastric wall, developing at a median of 19 months after primary resection; 82.4% underwent surgical resection of the seeding, while for 17.6%, palliative chemotherapy treatment. Follow-up after NTS diagnosis and treatment was reported for only twenty-three patients: when NTS was treated with surgery, the median overall survival was 26.5 months compared to 15.5 if treated with radio/chemotherapy. NTS after EUS-FNA of PDAC occurs late and might be treated aggressively with good results. Interestingly, only a low number of patients developing NTS underwent chemotherapy for the primary cancer, suggesting its possible protective role.
An 84-year-old man attended the emergency department because of jaundice, fever, and abdominal pain. Blood tests showed an increase in conjugated bilirubin and cholestasis markers. He un-▶ Fig. 1 Endoscopic view of intradiverticular papilla.▶ Fig. 2 Elastic-band traction technique with metallic clip of intradiverticular papilla.▶ Fig. 3 Endoscopic and radioscopic view of papilla dilation.
A 71-year-old woman with previous colorectal cancer was referred for a follow-up of a known pancreatic multifocal branch-duct intraductal papillary mucinous neoplasm (BD-IPMN). Computed tomography and magnetic resonance imaging performed in 2015 showed a 3-cm highly vascularized lesion suspicious for gastrointestinal stromal tumors uncertainly located between the antrum and duodenal bulb (Figure 1). A previous gastroscopy had shown a prepyloric semipedunculated submucosal lesion which was not reported in subsequent endoscopic ultrasound (EUS).
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.