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

Stefano Francesco Crinò; Maria Cristina Conti Bellocchi; Filippo Antonini; Giampiero Macarri; Silvia Carrara; Laura Lamonaca; Roberto Di Mitri; Elisabetta Conte; Carlo Fabbri; Cecilia Binda; Andrew Ofosu; Enrico Gasparini; Chiara Turri; Caterina Stornello; Ciro Celsa; Alberto Larghi; Erminia Manfrin; Armando Gabbrielli; Antonio Facciorusso; Matteo Tacelli

doi:10.4103/EUS-D-21-00118

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

Endosc Ultrasound. 2021 Nov-Dec;10(6):440-447. doi: 10.4103/EUS-D-21-00118.

Authors

Stefano Francesco Crinò¹, Maria Cristina Conti Bellocchi¹, Filippo Antonini², Giampiero Macarri², Silvia Carrara³, Laura Lamonaca³, Roberto Di Mitri⁴, Elisabetta Conte⁴, Carlo Fabbri⁵, Cecilia Binda⁵, Andrew Ofosu⁶, Enrico Gasparini¹, Chiara Turri¹, Caterina Stornello⁷, Ciro Celsa⁸, Alberto Larghi⁹, Erminia Manfrin¹⁰, Armando Gabbrielli¹, Antonio Facciorusso¹¹, Matteo Tacelli¹²

Affiliations

¹ Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy.
² Gastroenterology and Digestive Endoscopy Unit, Augusto Murri Hospital, Polytechnic University of Marche, Fermo, Italy.
³ Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy.
⁴ Gastroenterology and Endoscopy Unit, Arnas Civico Di Cristina Benfratelli Hospital, Palermo, Italy.
⁵ Gastroenterology and Digestive Endoscopy Unit, Forli-Cesena Hospitals, AUSL Romagna, Italy.
⁶ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
⁷ Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Italy.
⁸ Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties; Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy.
⁹ Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, Roma, Italy.
¹⁰ Department of Diagnostics and Public Health, G.B. Rossi University Hospital, Verona, Italy.
¹¹ Digestive Endoscopy Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy.
¹² Pancreato-biliary Endoscopy and EUS Division, San Raffaele Scientific Institute IRCCS, Milan, Italy.

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.

Keywords: biliary drainage; endoscopic retrograde cholangiopancreatography; fine-needle aspiration; fine-needle biopsy; pancreatic cancer.