1039 Mortality From Non Variceal Upper Gastrointestinal Bleeding in Patients With Liver Cirrhosis: an Individual Patient Data Meta-Analysis

EUS-FNA of solid pancreatic mass lesions. Methods: In this multi-center trial, patients with solid pancreatic masses were randomized to undergo EUS-FNA using a 19G or 25G needle. The Standard 19G needle was used for trans-gastric FNA and the Flexible 19G needle for trans-duodenal FNA. A pathologist blinded to randomization sequence evaluated specimens for onsite diagnostic sufficiency and later for presence of histological core tissue. Main outcome measures: Compare the median number of passes required to establish onsite diagnostic sufficiency, ability to procure histological samples, specimen quality (bloodiness graded as 33%, 34-66%, 67%), technical failures and complications using the 19 vs. 25-gauge FNA needles. Sample size: Estimation was based on median number of passes required to establish onsite diagnostic sufficiency. Results: Of the 72 randomized patients, there was no difference in patient demographics or disease characteristics between both groups. Pancreatic masses were located in the head/uncinate in 38 (58.7%) and in the body/tail in 34 (41.3%) patients with no difference in location between cohorts (p 0.77). The final diagnosis was adenocarcinoma in 49, neuroendocrine tumors in 6, chronic pancreatitis in 11, lymphoma in 2, metastatic or other neoplasm in 2 and indeterminate in 2. One patient randomized to 19G needle had intra-procedural bleeding and postprocedure fever that was managed conservatively. SUMMARY: While there was no difference in the median number of passes required to establish on-site diagnostic sufficiency between the 19 and 25G needles, the 19G needles were significantly better for core tissue procurement. Although more bloody, the current platform of 19G needles can procure samples from any location within the pancreas. Conclusions: As both the 19 and 25G needles perform equally well, the choice of an FNA needle for sampling pancreatic masses should be based on the need for core tissue.