Background and study aims: It is uncertain if needle gauge impacts the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic mass lesions. Our aim was to use meta-analysis to more robustly define the diagnostic accuracy of EUS-FNA for pancreatic masses using 22G and 25G needles.Patients and methods: Studies were identified by searching nine medical databases for reports published between 1994 and 2011, using a reproducible search strategy comprised of relevant terms. Only studies comparing the overall diagnostic accuracy of 22G vs. 25G EUS needles that used surgical histology or at least 6 months clinical follow up for a gold standard were included. Two reviewers independently scored the identified studies for methodology and abstracted pertinent data. When required, the original investigators were contacted to provide additional data. Pooling was conducted by both fixed-effects and random effects models. Diagnostic characteristics (sensitivity, specificity, positive and negative likelihood ratios) with 95% confidence intervals (CIs) were calculated.Results: Eight studies involving 1292 subjects met the defined inclusion criteria. Of the 1292 patients, 799 were in the 22G group and 565 were in the 25G group (both needles were used in 72 patients). The pooled sensitivity and specificity of the 22G needle were 0.85 (95 % CI 0.82-0.88) and 1 (95 % CI 0.98-1) respectively. The pooled sensitivity and specificity of the 25G needle were 0.93 (95 % CI 0.91-0.96) and 0.97 (95 % CI 0.93-0.99) respectively. The bivariate generalized linear random-effect model indicated that the 25G needle is associated with a higher sensitivity (P=0.0003) but comparable specificity (P=0.97) to the 22G needle.Conclusions: This meta-analysis suggests 25G needle systems are more sensitive than 22G needles for diagnosing pancreatic malignancy.

Introduction: The optimal way to deliver results of endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) of suspected pancreatic masses is unknown. Some centers receive preliminary results the day of the procedure but only convey final results to patients, and some centers do not receive preliminary results. Our center receives preliminary results, and provides these results to patients in the recovery area of the Endoscopy center prior to discharge. The aims of this study were to 1) learn patients' preference for receiving EUS FNA results, and 2) for patients who receive preliminary results, determine if they remember accurately what they were told. Methods: Consecutive patients referred for EUS FNA for possible pancreatic cancer were prospectively enrolled in the study. A pre-procedure survey assessed patients' knowledge about what test they were having, why they were having it and what they understood about the possible findings, as well as their preference for receiving results. This survey was administered prior to the procedure and prior to a discussion with the endoscopist. Patients were contacted by phone the day after the exam and asked if they remembered what test they had, why they had it, and what findings had been communicated to them the day before. A third survey was administered one week later during the phone call to communicate final cytology results. The survey was administered before the results were given, and asked the same questions as the one-day post procedure survey. Results: 10 women and 12 men were consecutively enrolled in the study. The average age was 65 years. The average number of school years completed was 10. The average pre-procedure anxiety score was 3.15 (0 = not at all, 5 = extremely). 12 of 22 (55%) patients knew they were having a biopsy/sample, 16 of 22 (73%) knew cancer/mass/growth/tumor was suspected. 20 of 22 (91%) wanted preliminary results the same day as the test and final results by phone one week later. 11 of 15 (73%) knew the correct preliminary diagnosis one day post-procedure, and 15 of 18 (83%) knew the correct preliminary diagnosis one week later (before given final results). Conclusions: Most patients referred to our institution for EUS FNA of possible pancreatic cancers prefer to receive preliminary results the same day, and receive final results by phone one week later. The large majority of patients in this study correctly remembered the preliminary diagnosis they were given.

BACKGROUND:The aim of this study was to determine the frequency and the severity of pancreatitis after EUS-guided FNA of solid pancreatic masses. A survey of centers that offer training in EUS in the United States was conducted.METHODS:A list of centers in which training in EUS is offered was obtained from the Web site of the American Society for Gastrointestinal Endoscopy. Designated program directors were contacted via e-mail. The information requested included the number of EUS-guided FNA procedures performed for solid pancreatic masses, the number of cases of post-procedure pancreatitis, and the method for tracking complications. For each episode of pancreatitis, technical details were obtained about the procedure, including the location of the mass, the type of fine needle used, the number of needle passes, and the nature of the lesion.RESULTS:Nineteen of the 27 programs contacted returned the questionnaire (70%). In total, 4909 EUS-guided FNAs of solid pancreatic masses were performed in these 19 centers over a mean of 4 years (range 11 months to 9 years). Pancreatitis occurred after 14 (0.29%): 95% CI[0.16, 0.48] procedures. At two centers in which data on complications were prospectively collected, the frequency of acute pancreatitis was 0.64%, suggesting that the frequency of pancreatitis in the retrospective cohort (0.26%) was under-reported (p=0.22). The odds that cases of pancreatitis would be reported were 2.45 greater for the prospective compared with the retrospective cohort (95% CI[0.55, 10.98]). The median duration of hospitalization for treatment of pancreatitis was 3 days (range 1-21 days). The pancreatitis was classified as mild in 10 cases, moderate in 3, and severe in one; one death (proximate cause, pulmonary embolism) occurred after the development of pancreatitis in a patient with multiple comorbid conditions.CONCLUSIONS:EUS-guided FNA of solid pancreatic masses is infrequently associated with acute pancreatitis. The procedure appears to be safe when performed by experienced endosonographers. The frequency of post EUS-guided FNA pancreatitis may be underestimated by retrospective analysis.

Background: Different methods have been proposed for pancreatic pseudocysts (PPC) drainage. We describe our experience in endoscopic drainage of PPC with a one step technique using a new therapeutic echo endoscope with a linear curved array transducer, a 3.7 mm working channel and an elevator (Olympus GF-UCT140-AL5). Methods: 12 patients (8 men, 4 women; mean age 53.9, range 28-77) were referred from October 2002 to October 2003 for endoscopic pseudocyst drainage. The mean size of the pancreatic cysts was 11.2 cm (6.5-25 cm). Either monitored anesthesia with Propofol or general anesthesia was used to sedate the patients. The Olympus GF-UCT140-AL5 was passed into the stomach; the optimal localization of the puncture site was determined. Color Doppler was used to rule out gastric varices and large vessels. Under real time ultrasound guidance a 19 gauge FNA needle (EchoTip, Wilson-Cook) was then inserted into the pseudocyst. A 0.025″ Jagwire (Boston Scientific) was passed through the needle under fluoroscopy and coiled into the pseudocyst. A Needle Knife (HPC-3) was introduced over the wire. Under EUS and endoscopic guidance an electrosurgical puncture was performed using the Needle Knife. The tract was dilated with a 10 mm balloon followed by the placement of 1 to 3 10-Fr double pigtail stents. The stents were removed in 1 to 3 months after the resolution of the cyst. Results: Drainage was not attempted on 2 patients due to large gastric varices on the first and a malignant mass in the cyst of the second, both diagnosed only by EUS. Drainage was attempted on 10 patients; placement of the 10-Fr double pigtail stents was successful in 9 patients. In one case drainage could not be achieved. In one other patient with a large cyst and internal debris surgery was required for a cyst infection that did not resolve with endoscopic management. 8/10 patients had complete resolution of their symptoms and cysts. One patient required 2 procedures due to the presence of debris in the cyst. There were no significant bleeding or other complications noted. Conclusion:In our experience EUS is essential prior to endoscopic drainage of PPC as it affected the clinical management of 2/12 patients. Endoscopic drainage of PPC using the new therapeutic echo endoscope with EUS guided wire placement and puncture allows a safe one step procedure without exchanging scopes.