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Endoscopy 2022; 54(12): 1158-1168
DOI: 10.1055/a-1831-5385
Original article

Predictors of adverse events after endoscopic ultrasound-guided through-the-needle biopsy of pancreatic cysts: a recursive partitioning analysis

Antonio Facciorusso 
 1   Department of Medical and Surgical Sciences, Section of Gastroenterology, University of Foggia, Foggia, Italy
 2   Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
,
Bojan Kovacevic
 3   Division of Endoscopy, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
,
Dennis Yang
 4   Center of Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
,
Filipe Vilas-Boas 
 5   Department of Gastroenterology, Centro Hospitalar e Universitário de São João-Porto, Porto, Portugal
,
Belén Martínez-Moreno
 6   Unidad de Endoscopia. ISABIAL, Hospital General Universitario de Alicante, Alicante, Spain
,
Serena Stigliano
 7   Operative Endoscopy Department, Campus Bio-Medico University Hospital, Rome, Italy
,
Gianenrico Rizzatti
 8   Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Marco Sacco 
 9   Gastroenterology Division, AOU Cittá della Salute e della Scienza di Torino, Turin, Italy
,
Martha Arevalo-Mora
10   Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
,
Leonardo Villarreal-Sanchez
11   Gastrocare, Digestive Diseases Center, Quito, Ecuador
,
Maria Cristina Conti Bellocchi
 2   Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
,
Laura Bernardoni
 2   Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
,
Armando Gabbrielli
 2   Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
,
Luca Barresi
12   Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Highly Specialized Therapies), Palermo, Italy
,
Paraskevas Gkolfakis
13   Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
,
Carlos Robles-Medranda 
10   Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
,
Claudio De Angelis
 9   Gastroenterology Division, AOU Cittá della Salute e della Scienza di Torino, Turin, Italy
,
Alberto Larghi
 8   Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Francesco Maria Di Matteo
 7   Operative Endoscopy Department, Campus Bio-Medico University Hospital, Rome, Italy
,
José R. Aparicio 
 6   Unidad de Endoscopia. ISABIAL, Hospital General Universitario de Alicante, Alicante, Spain
,
Guilherme Macedo
 5   Department of Gastroenterology, Centro Hospitalar e Universitário de São João-Porto, Porto, Portugal
,
Peter V. Draganov
14   Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA
,
Peter Vilmann
 3   Division of Endoscopy, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
,
Leandro Pecchia
15   School of Engineering, University of Warwick, Coventry, UK
,
Alessandro Repici
16   Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
17   IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
,
Stefano Francesco Crinò 
 2   Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
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Referred to by:

Author commentary on Antonio Facciorusso et al.Endoscopy 2022; 54(12): v43-v43
DOI: 10.1055/a-1842-3009

Referred to by:

Endoscopic ultrasound-guided through-the-needle biopsy for the diagnosis of cystic tumors of the pancreas: not for all patientsEndoscopy 2022; 54(12): 1169-1170
DOI: 10.1055/a-1901-8718

Abstract

Background and study aims Endoscopic ultrasound-guided through-the-needle biopsy (TTNB) of pancreatic cystic lesions (PCLs) is associated with a non-negligible risk for adverse events (AEs). We aimed to identify the hierarchic interaction among independent predictors for TTNB-related AEs and to generate a prognostic model using recursive partitioning analysis (RPA).

Patients and methods Multicenter retrospective analysis of 506 patients with PCLs who underwent TTNB. RPA of predictors for AEs was performed and the model was validated by means of bootstrap resampling.

Results Mean cysts size was 36.7 mm. Most common diagnoses were intraductal papillary mucinous neoplasm (IPMN, 45 %), serous cystadenoma (18.8 %), and mucinous cystadenoma (12.8 %). Fifty-eight (11.5 %) AEs were observed. At multivariate analysis, age (odds ratio [OR] 1.32, 1.09–2.14; p = 0.05), number of TTNB passes (OR from 2.17, 1.32–4.34 to OR 3.16, 2.03–6.34 with the increase of the number of passes), complete aspiration of the cyst (OR 0.56, 0.31–0.95; p = 0.02), and diagnosis of IPMN (OR 4.16, 2.27–7.69; p < 0.001) were found to be independent predictors of AEs, as confirmed by logistic regression and random forest analyses. RPA identified three risk classes: high-risk (IPMN sampled with multiple microforceps passes, 28 % AEs rate), low-risk (1.4 % AE rate, including patients < 64 years with other-than-IPMN diagnosis sampled with ≤ 2 microforceps passes and with complete aspiration of the cyst) and middle-risk class (6.1 % AEs rate, including the remaining patients).

Conclusion TTNB should be selectively used in the evaluation of patients with IPMN. The present model could be applied during patient selection as to optimize the benefit/risk of TTNB.

Appendix 1 s, Figs. 1 s–3 s, Tables 1 s, 2 s



Publication History

Received: 07 November 2021

Accepted after revision: 21 April 2022

Accepted Manuscript online:
21 April 2022

Article published online:
08 July 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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