Endoscopy 2021; 53(S 01): S71-S72
DOI: 10.1055/s-0041-1724432
Abstracts | ESGE Days
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Saturday, 27 March 2021 10:00 – 10:45 Can we still improve EUS diagnostic accuracy? Room 6

Contrast-Enhanced Harmonic Endoscopic Ultrasound (CH-EUS)-Guided Fine-Needle Aspiration Versus Standard Fine-Needle Aspiration In Pancreatic Masses: A Meta-Analysis

A Facciorusso
1   University of Foggia, 1Department of Surgical and Medical Sciences, Foggia, Italy
,
Mohan BP
2   University of Utah Health, Gastroenterology and Hepatology, Salt Lake City, United States
,
Crinò SF
3   University Hospital of Verona, Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, Verona, Italy
,
A Ofosu
4   Stanford University School of Medicine, Division of Gastroenterology and Hepatology, Stanford, United States
,
D Ramai
5   Brooklyn Hospital Medical Center, Gastroenterology and Hepatology, Brooklyn, United States
,
A Lisotti
6   University of Bologna, Hospital of Imola, Imola, Italy
,
S Chandan
7   CHI Health Creighton University Medical Center, Gastroenterology Unit, Omaha, United States
,
P Fusaroli
6   University of Bologna, Hospital of Imola, Imola, Italy
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Aims It is still unclear whether endoscopic ultrasound (EUS) contrast-enhanced Harmonic fine-needle aspiration (CH-EUS-FNA) determines superior results in comparison to standard EUS-FNA in tissue acquisition of pancreatic masses. The aim was to compare the pooled diagnostic performances of these two techniques.

Methods A systematic electronic search through PubMed/Medline and Embase database at the end of October 2020 was performed; all original articles dealing with the comparison of the diagnostic performance between CH-EUS-FNA and EUS-FNA were included. The primary outcome was diagnostic sensitivity; secondary outcomes included specificity, accuracy, sample adequacy, and number of needle passes. We performed pairwise meta-analysis through a random effects model and expressed data as odds ratio (OR) and 95 % confidence interval (CI).

Results Six studies (2 randomized controlled trials) have been identified; study outcomes were reported in the [table]. Pooled diagnostic sensitivity was 84.6 % (95 % CI 80.7-88.6 %) with CH-EUS-FNA and 75.3 % (67.0-83.5 %) with EUS-FNA, with evidence of a significant superiority of the former (OR 1.74, 95 % CI 1.26-2.40; p<0.001). Subgroup analysis confirmed the superiority of CH-EUS-FNA over EUS-FNA only in larger lesions (OR 2,38, 1.33-4.25 with the cut-off of 1.5 cm and OR 2.18, 1.12-3.01 with the cut-off of 2 cm). Pooled diagnostic sensitivity of CH-EUS-FNA was 86.2 % (79.7-92.7 %) in hypoenhanced and 89.4 % (82.8-96.0 %) in iso/hyperenhanced lesions (p=0.23). Pooled diagnostic accuracy was 88.8 % (85.6-91.9 %) in CH-EUS-FNA group and 83.6 % (79.4-87.8 %) in EUS-FNA group (OR 1.52, 1.01-2.31; p=0.05). Pooled sample adequacy was 95.1 % (91.1-99.1 %) with CH-EUS-FNA and 89.4 % (81.0-97.8 %) with EUS-FNA (OR 2.40, 1.38-4.17; p = 0.02). No difference in terms of number of needle passes was observed (mean difference: -0.10, -0.28 to 0.08; p = 0.29).

Tab. 1

No of studies analyzed No. in CH-EUS-FNA group No. in EUS-FNA group

Summary estimate (95 % CI)Pooled rate (95 % CI)

P-valueI2% heterogeneity

Sensitivity

6 studies;CH-EUS-FNA: 473 pts EUS-FNA: 520 pts

OR=1.74 (1.26-2.40)CH-EUS-FNA: 84.6 % (80.7-88.6 %)EUS-FNA: 75.3 % (67.0-83.5 %)

p < 0.001; 0 %

Specificity

6 studies;CH-EUS-FNA: 473 pts EUS-FNA: 520 pts

OR = 1.00 (0.9-1.01)CH-EUS-FNA: 100 % EUS-FNA: 100 %

p = 1.0; 0 %

Diagnostic accuracy

5 studies;CH-EUS-FNA: 380 pts EUS-FNA: 427 pts

OR=1.52 (1.01-2.31)CH-EUS-FNA: 88.8 % (85.6-91.9 %)EUS-FNA: 83.6 % (79.4-87.8 %)

p = 0.05; 0 %

Sample adequacy

5 studies;CH-EUS-FNA: 325 pts EUS-FNA: 372 pts

OR=2.40 (1.38-4.17)CH-EUS-FNA: 95.1 % (91.1-99.1 %)EUS-FNA: 89.4 % (81-97.8 %)

p=0.02; 0 %

Conclusions CH-EUS-FNA seems to be superior to standard EUS-FNA in patients with pancreatic masses. Further trials are needed to confirm these results.

Citation: Facciorusso A, Mohan BP, Crinò SF et al. OP175 CONTRAST-ENHANCED HARMONIC ENDOSCOPIC ULTRASOUND (CH-EUS)-GUIDED FINE-NEEDLE ASPIRATION VERSUS STANDARD FINE-NEEDLE ASPIRATION IN PANCREATIC MASSES: A META-ANALYSIS. Endoscopy 2021; 53: S71.



Publication History

Article published online:
19 March 2021

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