THREADING THE NEEDLE: DIAGNOSTIC YIELD OF ENDOSCOPIC ULTRASOUND GUIDED FINE NEEDLE ASPIRATION IN REAL WORLD CLINICAL PRACTICE

Aims:

The primary aim was to assess diagnostic yield of solid pancreatic lesions. Secondary outcomes include: assessing the number of passes performed and the presence of trainees on diagnostic yield.

Methods:

Electronic endoscopy recording system (EndoRad) identified patients that underwent endoscopic ultrasound (EUS) in 2017. Endoscopy reports were examined manually to identify if EUS guided sampling of solid pancreatic lesions was performed. Patient demographics, presence of trainee and number of passes with sampling needle were recorded from endoscopy reports. Pathology reports were examined to assess whether an adequate sample was received from EUS guided sampling.

Results:

388 EUS procedures were performed in 2017. 48 patients (12%) with solid pancreatic lesions underwent EUS guided tissue sampling. 77% (37/48) of procedures yielded an adequate tissue sample as per histology report. The higher the number of passes, the higher the proportion of samples having an adequate sample for diagnostic purposes, with yields of 89% (16/18) for 3 passes compared to 72% (13/18) and 67% (8/12) for two and one passes respectively. The presence of a trainee was associated with an increased diagnostic yield, 85% (23/27) versus 67% (14/21).

Conclusions:

This retrospective study demonstrates that a higher number of passes is associated with higher diagnostic yield, mirroring published clinical trials and interestingly that the presence of a trainee increases diagnostic yield. A standardised protocol for number of passes and needle type used may also warrant repeat audit in the future.