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Results of this study demonstrated no significant difference in the diagnostic yield of malignancy, proportion of inadequate specimens, and accuracy in patients with pancreatic mass undergoing EUS-FNA with or without OCE.

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Laparoscopic and open pancreatic cystgastrostomy both have a higher primary success rate than endoscopic internal drainage, although repeat endoscopic cystgastrostomy provides overall success for selected patients.

Background There is limited data on the safety of anesthesia-assisted endoscopy using propofol-mediated sedation in obese individuals undergoing advanced endoscopic procedures (AEPs). Objective To study the association between obesity [as measured by body mass index (BMI)] and the frequency of sedation-related complications (SRCs) in patients undergoing AEPs. Design Prospective cohort study. Setting Tertiary referral center. Patients 1016 consecutive patients undergoing AEPs [BMI<30: 730(72%), 30-35:159(16%), >35:127(12%)]. Intervention Monitored anesthesia sedation with propofol alone or in combination with benzodiazepines and/or opioids. Main Outcome Measures SRCs: airway modifications (AMs), hypoxemia, hypotension requiring vasopressors, and early procedure termination were compared across three groups. Results There were 203 AMs in 13.9% patients, hypoxemia in 7.3%, need for vasopressors in 0.8% and premature termination in 0.6% of patients. Increasing BMI was associated with an increased frequency of AMs (BMI:<30–10.5%, 30-35–18.9%, >35–26.8%, p<0.001) and hypoxemia (<30–5.3%, 30-35–9.4%, >35–13.4%, p=0.001); there was no difference in the frequency of need for vasopressors (p=0.254) and premature termination of procedures (p=0.401). On multivariable analysis, BMI [OR 2.0 (95% CI 1.3-3.1)], age [OR 1.1 (95% CI 1.0-1.1)] and ASA class ≥ 3 [OR 2.4 (95% CI 1.1-5.0)] were independent predictors of SRCs. In obese individuals (n=286), there was no difference in the frequency of SRCs in patients receiving propofol alone or in combination (p=0.48). Limitations Single tertiary center study. Conclusions Although obesity was associated with an increased frequency of SRCs, propofol sedation can be used safely in obese patients undergoing AEPs when administered by trained professionals.

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