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

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 aspirat...

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Detalles Bibliográficos
Autores principales: Facciorusso, Antonio, Barresi, Luca, Cannizzaro, Renato, Antonini, Filippo, Triantafyllou, Konstantinos, Tziatzios, Georgios, Muscatiello, Nicola, Hart, Phil A., Wani, Sachin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2021
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775812/
https://www.ncbi.nlm.nih.gov/pubmed/33403238
http://dx.doi.org/10.1055/a-1293-7279
Descripción
Sumario: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.