Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Nov 16, 2019; 11(11): 531-540
Published online Nov 16, 2019. doi: 10.4253/wjge.v11.i11.531
Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: A large single center experience
Rintaro Hashimoto, John G Lee, Kenneth J Chang, Nabil El Hage Chehade, Jason B Samarasena
Rintaro Hashimoto, John G Lee, Kenneth J Chang, Nabil El Hage Chehade, Jason B Samarasena, H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California, Irvine, Orange, CA 92868, United States
Author contributions: All authors helped to perform the research; Hashimoto R manuscript writing, performing procedures and data analysis; Lee JG and Chang KJ performing procedures; El Hage Chegade N manuscript writing; Samarasena JB contribution to performing procedures and drafting conception.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of University of California Irvine Medical Center.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: No financial support was received from the company of microforceps to conduct this study. Dr Samarasena is a consultant to US Endoscopy. None of the other authors have any relevant conflicts of interest.
Data sharing statement: No data is shared.
STROBE statement: All the statement is checked.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Rintaro Hashimoto, MD, PhD, Doctor, H. H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California, Irvine, 333 City Blvd West, Suite 400, Orange, CA 92868, United States. rintaroh@uci.edu
Telephone: +1-714-4566745 Fax: +1-714-4567753
Received: March 18, 2019
Peer-review started: March 18, 2019
First decision: May 9, 2019
Revised: September 25, 2019
Accepted: October 18, 2019
Article in press: October 18, 2019
Published online: November 16, 2019
ARTICLE HIGHLIGHTS
Research background

Pancreatic cysts are increasingly being identified in asymptomatic patients. Establishing a diagnosis of pancreatic cystic lesions (PCLs) preoperatively still remains a challenge. Endoscopic ultrasound (EUS)-fine-needle aspiration (FNA) showed high specificity in diagnosing mucinous cysts and high grade atypia. However, the sensitivity is not enough high because of relatively acellular samples. Recently, EUS-through-the-needle biopsy (EUS-TTNB) using microforceps was recently used to make a definitive diagnosis of PCLs. There have been some studies showing the efficacy and safety of EUS-TTNB for PCLs.

Research motivation

The number of studies describing the safety and efficacy of EUS-TTNB is still small. There have been no study evaluating the feasibility of intraductal papillary mucinous neoplasm (IPMN) subtyping using EUS-TTNB specimen.

Research objectives

The aim of this study was to evaluate the safety and efficacy of EUS-TTNB, compare the tissue acquisition and diagnostic tissue yield of EUS-TTNB with EUS-FNA, and assess the feasibility of IPMN subtyping using EUS-TTNB specimen.

Research methods

A retrospective analysis of endoscopy reporting system and medical records of patients who underwent EUS-TTNB for PCLs was conducted. The review and analysis were conducted through our endoscopy reporting system (endoPRO iQ®) and medical records.

Research results

A total of 56 patients with PCLs were included. The clinical success rate using EUS-TTNB (80.4%) was much higher than EUS-FNA (25%). Adverse events occurred only in 2 patients (3.6%) who developed mild pancreatitis that resolved with medical therapy. Subtyping of IPMN was successful in 23 of 32 cases (71.9%) using TTNB specimens.

Research conclusions

EUS-TTNB is a safe and feasible procedure for evaluation of PCLs. The clinical success rate was higher in EUS-TTNB than in EUS-FNA. IPMN subtype was also possible in many cases.

Research perspectives

Given recent development of genetic mutation analysis of PCLs, risk stratification using EUS-TTNB specimen might be possible in the future.