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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(01): E66-E75
DOI: 10.1055/a-1293-7279
Original article

Diagnostic yield of endoscopic ultrasound-guided tissue acquisition in autoimmune pancreatitis: a systematic review and meta-analysis

Antonio Facciorusso
1   Endoscopy Unit, University of Foggia, Foggia, Italy
,
Luca Barresi
2   Endoscopy Service, Department of Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS – ISMETT), Palermo, Italy
,
Renato Cannizzaro
3   Oncological Gastroenterology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
,
Filippo Antonini
4   Gastroenterology and Endoscopy Unit, Marche Polytechnic University, A. Murri Hospital, Fermo, Italy
,
Konstantinos Triantafyllou
5   Hepatogastroenterology Unit, Second Department of Internal Medicine – Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Athens, Greece
,
Georgios Tziatzios
5   Hepatogastroenterology Unit, Second Department of Internal Medicine – Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Athens, Greece
,
Nicola Muscatiello
1   Endoscopy Unit, University of Foggia, Foggia, Italy
,
Phil A. Hart
6   Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
,
Sachin Wani
7   University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
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Abstract

Background and study aims There is limited evidence on the diagnostic performance of endoscopic ultrasound (EUS)-guided tissue acquisition in autoimmune pancreatitis (AIP). The aim of this meta-analysis was to provide a pooled estimate of the diagnostic performance of EUS-guided fine-needle aspiration (FNA) and fine-needle biopsy (FNB) in patients with AIP.

Patients and methods Computerized bibliographic search was performed through January 2020. Pooled effects were calculated using a random-effects model by means of DerSimonian and Laird test. Primary endpoint was diagnostic accuracy compared to clinical diagnostic criteria. Additional outcomes were definitive histopathology, pooled rates of adequate material for histological diagnosis, sample adequacy, mean number of needle passes. Diagnostic sensitivity and safety data were also analyzed.

Results Fifteen studies with 631 patients were included, of which four were prospective series and one randomized trial. Overall diagnostic accuracy of EUS tissue acquisition was 54.7 % (95 % confidence interval, 40.9 %–68.4 %), with a clear superiority of FNB over FNA (63 %, 52.7 % to 73.4 % versus 45.7 %, 26.5 %–65 %; p < 0.001). FNB provided level 1 of histological diagnosis in 44.2 % of cases (30.8 %–57.5 %) as compared to 21.9 % (10 %–33.7 %) with FNA (P < 0.001). The rate of definitive histopathology of EUS tissue sampling was 20.7 % (12.9 %–28.5 %) and it was significantly higher with FNB (24.3 %, 11.8 %–36.8 %) as compared to FNA (14.7 %, 5.4 %–23.9 %; P < 0.001). Less than 1 % of subjects experienced post-procedural acute pancreatitis.

Conclusion The results of this meta-analysis demonstrate that the diagnostic performance of EUS-guided tissue acquisition is modest in patients with AIP, with an improved performance of FNB compared to FNA.

Supplementary material



Publication History

Received: 13 July 2020

Accepted: 28 September 2020

Article published online:
01 January 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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