Utility of Eus-Guided Through the Needle Microbiopsy in Influencing Management Outcomes of Patients With Cystic Lesions: A Single Centre Experience

Aims The recent development of through-the-needle microbiopsy (TTNB) forceps via endoscopic ultrasound (EUS) has facilitated sampling of pancreatic cyst walls for histological analysis. This novel method has added to the armamentarium of the currently available radiological, biochemical and cytological modalities in the diagnostic algorithm of patients with pancreatic cystic lesions (PCL). We aimed to describe the utility of EUS-TTNB in influencing management outcomes at a tertiary hepatopancreatobiliary unit.

Methods A prospective database of consecutive patients who underwent EUS-TTNB from March 2020 to October 2020 was retrospectively analysed. Recorded variables included patient demographics, technical success, histological results, adverse events and management outcomes.

Results Seven patients (4 male; 3 female) were identified. All patients were discussed in dedicated multidisciplinary team (MDT) meetings and a consensus on the nature of the lesion was not possible. Seven patients had PCLs and one patient had a retroperitoneal cystic lesion. Technical success was achieved in 100 % of patients. Specimen adequacy for definitive histological diagnosis was achieved in 85.7 % of patients (n = 6), leading to a change in management. An adverse event was encountered in one patient* who developed an infection of the cystic lesion post EUS-TTNB. After extensive MDT discussion, EUS guided drainage was performed resulting in good clinical response. The table summarises the key characteristics and outcomes of the patients.

Patient	Lesion location	Size on EUS (mm)	Pre-TTNB MDT diagnosis	Post-TTNB histological diagnosis	Outcome	Adverse events
1	HOP	35	IPMN vs. SCN	IPMN	Start surveillance	No
2	TOP	33	Indeterminate	Indeterminate	Continue surveillance	No
3	Retroperitoneal	250	GIST	GIST	Chemotherapy	Yes
4	BOP	35	MCN	Lymphoepithelial cyst	Avoided surgery	No
5	HOP	40	SB-IPMN vs. MCN	SCN	Avoided surveillance	No
6	BOP	50	SB-IPMN	SCN	Avoided surveillance	No
7	BOP	40	IPMN vs. MCN	MCN	Surgery	No

Conclusions Our case series has demonstrated EUS-TTNB to be a valuable and safe tool in the diagnostic pathway of patients with cystic lesions and led to a change in management in the majority of patients. Further larger prospective studies are required.

Citation On W, Paranandi B, Huggett MT et al. eP395 UTILITY OF EUS-GUIDED THROUGH THE NEEDLE MICROBIOPSY IN INFLUENCING MANAGEMENT OUTCOMES OF PATIENTS WITH CYSTIC LESIONS: A SINGLE CENTRE EXPERIENCE. Endoscopy 2021; 53: S225.

Publication History

Article published online:
19 March 2021