Does General Anesthesia Increase the Diagnostic Yield of Endoscopic Ultrasound-guided Fine Needle Aspiration of Pancreatic Masses?

Ootaki, Chiyo; Stevens, Tyler; Vargo, John J.; You, Jing; Shiba, Ayako; Foss, Joseph F.; Borkowski, Raymond; Mäurer, W

doi:10.1097/aln.0b013e31826e0590

Cited by 31 publications

(11 citation statements)

References 30 publications

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“…Because cost-effectiveness of sedation with propofol has not been established, the American and European Society of Gastroenterology do not take a stand on this subject 11 13 . Although we did not ask participants for the reasons behind their choice, previous studies have suggested that the increased use of propofol in the United States is caused by: 1) the believe that it improves the diagnostic accuracy of EUS-guided tissue sampling; 2) efforts to offset falling procedure reimbursements; and 3) marketing strategies of anesthesiologists 13 21 22 .…”

Section: Discussionmentioning

confidence: 99%

Mapping international practice patterns in EUS-guided tissue sampling: outcome of a global survey

et al. 2016

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Background and study aims: Although Endoscopic Ultrasound (EUS)-guided tissue sampling is widely used, the optimal sampling strategy remains subject of debate. We evaluated practice patterns within the international endosonographic community. Patients and methods: An online questionnaire was sent to 400 endosonographers from the United States, Europe, and Asia. Results: A total of 186 (47 %) endosonographers participated: United States 54 (29 %), Europe 85 (46 %), and Asia 47 (25 %). European (75 %) and Asian (84 %) respondents routinely check coagulation status, whereas US respondents only check on indication (64 %, P = 0.007). While propofol sedation is standard in the United States (83 %), conscious sedation is still widely used in Europe (52 %) and Asia (84 %, P < 0.001). Overall, the 22-gauge needle is most commonly used (52 %). For fine-needle aspiration (FNA) of solid pancreatic lesions, 22-gauge (45 %) and 25-gauge (49 %) needles are used equally. For fine-needle biopsy (FNB) of solid masses, the 25-gauge device is less favored than the 22-gauge FNA device (49 % versus 21 %). The 19-gauge needle is generally used for FNB of submucosal masses (62 %). Rapid on-site pathological evaluation (ROSE) is utilized more often by US (98 %) than by European and Asian respondents (51 %, P < 0.001). Cytolyt (52 %), formalin (15 %) and alcohol (15 %) are used for FNA specimen preservation in the United States and Europe, while saline (27 %) and alcohol (38 %) are widely used in Asia (P < 0.001). Conclusions: EUS-guided tissue sampling practices vary substantially within the international endosonographic community and differ considerably from recommendations expressed in guidelines. Because the clinical relevance of these variations is largely unknown, the outcome of this survey suggests a need for further studies.

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Section: Discussionmentioning

confidence: 99%

Mapping international practice patterns in EUS-guided tissue sampling: outcome of a global survey

et al. 2016

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“…The first task in performing high quality EUS-FNA involves locating the target tissue and determining the ideal needle approach. Perhaps for this reason, use of general anesthesia has shown to be associated with increased diagnostic yield (83% with vs 73% without) during EUS-FNA of pancreatic mass lesions[ 21 ]. However this was a single center retrospective study and further study is required to confirm these results.…”

Section: Eus-fna Techniquementioning

confidence: 99%

Endoscopic ultrasound-guided techniques for diagnosing pancreatic mass lesions: Can we do better?

Storm¹,

Lee²

2016

WJG

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The diagnostic approach to a possible pancreatic mass lesion relies first upon various non-invasive imaging modalities, including computed tomography, ultrasound, and magnetic resonance imaging techniques. Once a suspect lesion has been identified, tissue acquisition for characterization of the lesion is often paramount in developing an individualized therapeutic approach. Given the high prevalence and mortality associated with pancreatic cancer, an ideal approach to diagnosing pancreatic mass lesions would be safe, highly sensitive, and reproducible across various practice settings. Tools, in addition to radiologic imaging, currently employed in the initial evaluation of a patient with a pancreatic mass lesion include serum tumor markers, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). EUS-FNA has grown to become the gold standard in tissue diagnosis of pancreatic lesions.

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“…In a retrospective study on 371 patients it was shown that using general anesthesia (either with or without intubation) increased significantly the rate of cytological diagnosis compared to conscious sedation. [20] Finally, in cases with a high suspicion of cancer and previous inconclusive or negative FNA findings, studies have shown a benefit in increasing final number of true positive results when procedure is repeated. [2122]…”

Section: Performance Of Eus-fna According Type Of Pathologymentioning

confidence: 99%

How good is fine needle aspiration? What results should you expect?

Eisendrath

2014

Endosc Ultrasound

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Tissue acquisition plays a key role before treatment decision in most of oncological pathologies but also in several benign diseases. By offering tissue sampling, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become an essential tool in the diagnostic processes. One of the reasons for the success of the technique is related to its excellent diagnostic performance. The diagnostic accuracy of EUS-FNA is above 80% for most of the usual indications. These performances are however dependent on some factors related to both the disease and patient's medical history but also related to medical staff expertise. Endoscopist needs to know how to reach a lesion but also how to efficiently acquire good tissue samples. This review aims to report general recommendations available in the literature for high quality EUS-FNA. Sample processing and sample interpretation also influence diagnostic accuracy of FNA. This paper includes a discussion on sample processing and benefits of the on-site pathology examination. It also provides the results reported in the literature of sample adequacy and diagnostic performance of EUS-FNA for most common indications: Pancreatic diseases, sub-mucosal lesion, mucosal thickenings, lymph nodes, cystic lesion and free fluids.

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Does General Anesthesia Increase the Diagnostic Yield of Endoscopic Ultrasound-guided Fine Needle Aspiration of Pancreatic Masses?

Abstract: : 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.

Cited by 31 publications

References 30 publications

Mapping international practice patterns in EUS-guided tissue sampling: outcome of a global survey

Mapping international practice patterns in EUS-guided tissue sampling: outcome of a global survey

Endoscopic ultrasound-guided techniques for diagnosing pancreatic mass lesions: Can we do better?

How good is fine needle aspiration? What results should you expect?

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