Impact of biliary stents on the diagnostic accuracy of EUS-guided fine-needle biopsy of solid pancreatic head lesions: A multicenter study

Abstract

Background and Objectives: There is no clear evidence of a negative impact of biliary stents on the diagnostic yield of EUS-guided fine-needle biopsy (EUS-FNB) for diagnosing pancreatic head lesions. We aimed to evaluate the association between the presence of biliary stents and the diagnostic accuracy of EUS-FNB. Materials and Methods: A multicenter retrospective study including all jaundiced patients secondary to pancreatic head masses was performed. Patients were divided into two groups according to the presence of a biliary stent placed before EUS-FNB. Pathological results were classified according to the Papanicolaou classification and compared against the final diagnosis. Diagnostic measures in the two groups were compared. Multivariate logistic regression analyses including potential factors affecting EUS-FNB accuracy were performed. Results: Overall, 842 patients were included, 495 (58.8%) without and 347 (41.2%) with biliary stent. A plastic or a metal stent was placed in 217 (62.5%) and 130 (37.5%) cases, respectively. Diagnostic sensitivity and accuracy were significantly higher in patients without biliary stent than in those with stent (91.9% and 92.1% vs . 85.9% and 86.4%, P = 0.010 At multivariate analyses, lesion size (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.02–1.09, P = 0.01) and presence of biliary stent (OR: 0.51, 95% CI: 0.32–0.89, P = 0.01) were independently associated with diagnostic accuracy. In the subgroup of patients with biliary stent, the type of stent (plastic vs . metal) did not impact EUS-FNB yield, whereas the use of larger bore needles enhanced diagnostic accuracy (OR: 2.29, 95% CI: 1.28–4.12, P = 0.005). Conclusions: In this large retrospective study, an indwelling biliary stent negatively impacted the diagnostic accuracy of EUS-FNB. Preferably, EUS-FNB should precede endoscopic retrograde cholangiopancreatography, especially in the case of small tumors.

Do Biliary Stents Affect EUS-Guided Tissue Acquisition (EUS-TA) in Solid Pancreatic Lesions Determining Biliary Obstruction? A Literature Review with Meta-Analysis

“…From 91 studies identified using the search strategy, we included seven retrospective case-control studies [ 10 , 11 , 12 , 13 , 18 , 19 , 20 ] ( Figure 1 ) with 2458 patients.…”

“…There is conflicting evidence regarding the impact of biliary stents on the diagnostic accuracy of EUS-TA. This is likely due to poor visualization of the lesion from acoustic shadowing, reverberation and/or surrounding inflammation associated with the stent [ 9 , 10 , 11 ]. Additionally, these studies seem to suggest that plastic or self-expandable metal stents (SEMSs) could have a dissimilar effect because of differences in their material and diameter.…”

“…Additionally, these studies seem to suggest that plastic or self-expandable metal stents (SEMSs) could have a dissimilar effect because of differences in their material and diameter. While previously published reports have suggested that the presence of biliary plastic stents or SEMSs does not influence the diagnostic accuracy of EUS-guided fine-needle aspiration (EUS-FNA) in pancreatic head lesions [ 9 , 10 , 11 , 12 ], Kim et al reported a decrease in the accuracy of EUS-FNA with concomitant stents, regardless of their type [ 13 ]. The negative impact of biliary stents on EUS-guided fine-needle biopsy (FNB) has been further confirmed in a recent large multicenter Italian series [ 11 ].…”

“…While previously published reports have suggested that the presence of biliary plastic stents or SEMSs does not influence the diagnostic accuracy of EUS-guided fine-needle aspiration (EUS-FNA) in pancreatic head lesions [ 9 , 10 , 11 , 12 ], Kim et al reported a decrease in the accuracy of EUS-FNA with concomitant stents, regardless of their type [ 13 ]. The negative impact of biliary stents on EUS-guided fine-needle biopsy (FNB) has been further confirmed in a recent large multicenter Italian series [ 11 ]. Another recent retrospective analysis by Oppong et al [ 14 ] analyzed the ability of EUS to diagnose pancreatic lesions for suitability in terms of surgical resection based on whether a bile duct stent was present or not.…”

Endoscopic Ultrasound in the Diagnosis of Extrahepatic Cholangiocarcinoma: What Do We Know in 2023?

“…Biliary stents can lower the diagnostic accuracy of EUS-FNA from 95 to 65% in distal lesions, and from 86 to 56% in perihilar lesions because the access of the needle beyond the stent is restricted [ 76 ]. For this reason, it is recommended to remove the stent prior to EUS tissue acquisition, similar to pancreatic pathology, in which the diagnostic value of EUS-FNB is diminished by the presence of a biliary stent, regardless of its type [ 82 ]. Moreover, in the case of primary sclerosing cholangitis, the presence of multiple biliary stenosis and benign lymphadenopathy may make EUS-FNA more difficult [ 56 , 76 ].…”