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OC.17.3 DIAGNOSTIC ACCURACY OF FNA (FINE NEEDLE ASPIRATION) ON SOLID PANCREATIC LESIONS: IS ASPIRATION-RELATED?
Abstracts of the 20th National Congress of Digestive Diseases / Digestive and Liver Disease 46S (2014) S1–S144 OC.17.2 ENDOSCOPIC TREATMENT OF CHRONIC PANCREATITIS IN CHILDREN: LONG TERM FOLLOW UP M. Napoleone ∗,1 , I. Boskoski 1 , P. Familiari 1 , A. Tringali 1 , V. Perri 1 , F. Iacopini 1 , M. Mutignani 2 , G. Costamagna 1 1 Ospedale
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tively included. The masses had a mean size of 32.21±11.24mm. The sample adequacy evaluated on-site was 87.5% with 20ml aspiration vs. 76.1% with 10 ml (p=0.051 two-sided p=0.025 one-side), and 45.4% without aspiration (20ml vs.0 ml p=0.000; 10ml vs. 0 ml p=0.000). The diagnostic accuracy was significantly better with 20ml than with 10ml and 0ml (86.2% vs. 69.0% vs. 49.4% p=0.000).
Gemelli, Roma, Italy; 2 Ospedale Niguarda, Milano, Italy
Background and aim: Chronic pancreatitis (CP) in children is rare. ERCP experience in children with CP is limited. Safety and efficacy of ERCP for the treatment of CP in children was evaluated. Material and methods: All pediatric pts (<18yrs) with CP who underwent ERCP from Oct 1992 to Feb 2013 in a single referral center were identified from a prospective database. Indications, findings, treatment modalities, outcomes and adverse events were recorded. Data on long term f-up were evaluated. Results: One hundred twenty-five children underwent ERCP during the study period. Of these, 35 (28%) patients (16 boys, mean age 11.6 yrs) had CP and were included. A total of 110 ERCPs were performed (3.1/patient). Mean f-up was 8 yrs (0.7-21 yrs). Indications to ERCP were recurrent bouts of pancreatitis and pain. Eighteen (51.4%) pts had pancreatic stones/plugs; 10 (28.5%) pts had a pancreas divisum, 3 (8.6%) a “Dominant Santorini duct” anatomy, 3 an “H-shaped” duct configuration, 1 (2.9%) an “ansa pancreatica”. Major papilla pancreatic sphincterotomy was performed in 26 pts, minor papilla sphincterotomy in 14 (5 had both major and minor papilla sphincterotomy). Ten pts underwent also a biliary sphincterotomy. Extracorporeal Shock-Wave Lithotripsy (ESWL) on pancreatic stones was performed in 3 cases. At initial ERCP, 18 pts underwent sphincterotomy and stone extraction; 3 of these pts underwent stent placement for a dominant stricture; 17 pts underwent only a pancreatic sphincterotomy. ERCP-related complications (bleeding and pancreatitis) occurred in 2 pts (5.7%). Thirteen (37.1%) children underwent a single ERCP, and were symptom free after a median of 6.2 yrs (range 0.7–14). Twenty-two (62.9%) pts had symptom recurrence after a median of 4,6 yrs (range 0.8–20.4) and underwent additional ERCP (a total of 75 procedures [range 1–14; 3.5/patient]). Nine/22 pts with recurrences were treated with plastic stents for a cephalic stricture, and were symptom-free 5.5 yrs (range 0.3–14.7) after stent removal. Thirteen pts underwent ERCP for re-sphincterotomy and/or papilla pneumatic dilation and were symptom free after 3.6 yrs (0.3-5.6). Conclusions: ERCP in pediatric patients with chronic pancreatitis is a safe and effective procedure. In more than one third of cases only one ERCP can be resolutive. Symptom recurrences can be easily managed without major complications.
OC.17.3 DIAGNOSTIC ACCURACY OF FNA (FINE NEEDLE ASPIRATION) ON SOLID PANCREATIC LESIONS: IS ASPIRATION-RELATED? I. Tarantino ∗,1 , R. Di Mitri 2 , C. Fabbri 3 , N. Pagano 4 , L. Barresi 1 , A. Granata 1 , R. Liotta 1 , F. Mocciaro 2 , A. Maimone 3 , P. Baccarini 3 , F. Tuzzolino 1 , G. Curcio 1 , A. Repici 4 , M. Traina 1 1 ISMETT/UPMC
Italy, Palermo, Italy; 2 A.R.N.A.S. Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy; 3 Ospedale Bellaria Maggiore, Bologna, Italy; 4 Istituto Clinico Humanitas, Rozzano, Milano, Italy Background and aim: EUS-FNA plays a central role in the diagnostic algorithm of solid pancreatic masses. Different needle diameters and the use of a stylet are not associated with differences in terms of diagnostic yield. Our aim was to compare EUS-FNA in the same solid pancreatic mass done with a 22-gauge needle with different aspiration volumes (20, 10, 0ml), looking for adequacy, diagnostic accuracy and, complications. Material and methods: Prospective clinical study at four referral centers. EUS was performed by five experienced echo-endoscopist. The needle was in all cases 22-gauge. We performed three punctures in the same mass with a 22-gauge needle at a volume aspiration of 20 and 10 cc, and without syringe. The sequence was randomly assigned. The cytopathologist was always blinded as to which aspiration was used for which specimen. Results: Eighty-eight patients with solid pancreatic masses were consecu-
Conclusions: Considering the significantly higher sensitivity and accuracy that we found with the 20ml aspiration puncture, we can conclude that performing all passes with this volume aspiration may largely improve cellular adequacy and the final diagnostic accuracy of FNA in solid pancreatic masses.
OC.17.4 FEASIBILITY AND DIAGNOSTIC YIELD OF A NEW EUS CITO-HISTOLOGIC NEEDLE IN COMPARISON WITH STANDARD EUS-FINE NEEDLE ASPIRATION: A 2-YEAR SINGLE-CENTRE EXPERIENCE C.G. De Angelis ∗ , S. Gaia, S.F. Manfrè, A. Andrealli, M. Bruno, P. Carucci, D. Pacchioni, A. Cassenti, R. Senetta, L. Molinaro, G. Gatti, A. Sapino, M. Rizzetto Città della Salute e della Scienza, Turin, Italy Background and aim: Fine Needle Aspiration (FNA) under EUS guidance is an efficient and safe method to obtain tissue samples from the GI tract and from the nearest structures. Whereas EUS-FNA provides samples of cells without any tissue structure information, EUS-Fine Needle Biopsy (FNB) has the theorethical advantage to collect tissue for histological evaluation. The aim of this study is to compare feasibility and diagnostic yield of the new FNB device (Cook EchoTip ProCore) with the standard FNA needles. Material and methods: 134 patients (75/59 M/F; 62±13.5 years) were consecutively enrolled between April 2011 and June 2013, for a total of 137 lesions (mean size 33.5±16 mm, range: 6–100 mm): 81 pancreas, 31 lymph nodes, 8 stomach, 7 gut (including 1 papilla), 4 esophagus, 5 aspecific abdominal masses, 1 nervous ganglia. For each lesion EUS-guided tissue sampling was performed both with standard needle and with ProCore needle. An expert cytopathologist evaluated the material assessing the feasibility of the diagnosis on the samples from the two types of needle. Results: A mean of 3.2±1.1 (range 1–6) and 2.8±1.1 (range 1–7) needle passes per lesion were performed with standard needles and ProCore respectively. A core sample adequate for histological assessment from ProCore biopsy was achieved in 29% lesions, 37% of lesions however fitted for cytological evaluation, whereas 34% were inadequate. A final diagnosis was reached 84% cases; 66% of the ProCore samples and 67% of the standard needle samples (p: ns; Standard Echo alone versus both: p 0.009; ProCore alone versus both: p 0.005). In 16.5% the diagnosis was reached only on the ProCore sample. No complications were observed. Conclusions: EUS-FNB is feasible and safe, but only in 29% of cases a core sample adequate for histological evaluation was obtained. The success rate in reaching the diagnosis is similar with standard needles and with ProCore
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tively included. The masses had a mean size of 32.21±11.24mm. The sample adequacy evaluated on-site was 87.5% with 20ml aspiration vs. 76.1% with 10 ml (p=0.051 two-sided p=0.025 one-side), and 45.4% without aspiration (20ml vs.0 ml p=0.000; 10ml vs. 0 ml p=0.000). The diagnostic accuracy was significantly better with 20ml than with 10ml and 0ml (86.2% vs. 69.0% vs. 49.4% p=0.000).
Gemelli, Roma, Italy; 2 Ospedale Niguarda, Milano, Italy
Background and aim: Chronic pancreatitis (CP) in children is rare. ERCP experience in children with CP is limited. Safety and efficacy of ERCP for the treatment of CP in children was evaluated. Material and methods: All pediatric pts (<18yrs) with CP who underwent ERCP from Oct 1992 to Feb 2013 in a single referral center were identified from a prospective database. Indications, findings, treatment modalities, outcomes and adverse events were recorded. Data on long term f-up were evaluated. Results: One hundred twenty-five children underwent ERCP during the study period. Of these, 35 (28%) patients (16 boys, mean age 11.6 yrs) had CP and were included. A total of 110 ERCPs were performed (3.1/patient). Mean f-up was 8 yrs (0.7-21 yrs). Indications to ERCP were recurrent bouts of pancreatitis and pain. Eighteen (51.4%) pts had pancreatic stones/plugs; 10 (28.5%) pts had a pancreas divisum, 3 (8.6%) a “Dominant Santorini duct” anatomy, 3 an “H-shaped” duct configuration, 1 (2.9%) an “ansa pancreatica”. Major papilla pancreatic sphincterotomy was performed in 26 pts, minor papilla sphincterotomy in 14 (5 had both major and minor papilla sphincterotomy). Ten pts underwent also a biliary sphincterotomy. Extracorporeal Shock-Wave Lithotripsy (ESWL) on pancreatic stones was performed in 3 cases. At initial ERCP, 18 pts underwent sphincterotomy and stone extraction; 3 of these pts underwent stent placement for a dominant stricture; 17 pts underwent only a pancreatic sphincterotomy. ERCP-related complications (bleeding and pancreatitis) occurred in 2 pts (5.7%). Thirteen (37.1%) children underwent a single ERCP, and were symptom free after a median of 6.2 yrs (range 0.7–14). Twenty-two (62.9%) pts had symptom recurrence after a median of 4,6 yrs (range 0.8–20.4) and underwent additional ERCP (a total of 75 procedures [range 1–14; 3.5/patient]). Nine/22 pts with recurrences were treated with plastic stents for a cephalic stricture, and were symptom-free 5.5 yrs (range 0.3–14.7) after stent removal. Thirteen pts underwent ERCP for re-sphincterotomy and/or papilla pneumatic dilation and were symptom free after 3.6 yrs (0.3-5.6). Conclusions: ERCP in pediatric patients with chronic pancreatitis is a safe and effective procedure. In more than one third of cases only one ERCP can be resolutive. Symptom recurrences can be easily managed without major complications.
OC.17.3 DIAGNOSTIC ACCURACY OF FNA (FINE NEEDLE ASPIRATION) ON SOLID PANCREATIC LESIONS: IS ASPIRATION-RELATED? I. Tarantino ∗,1 , R. Di Mitri 2 , C. Fabbri 3 , N. Pagano 4 , L. Barresi 1 , A. Granata 1 , R. Liotta 1 , F. Mocciaro 2 , A. Maimone 3 , P. Baccarini 3 , F. Tuzzolino 1 , G. Curcio 1 , A. Repici 4 , M. Traina 1 1 ISMETT/UPMC
Italy, Palermo, Italy; 2 A.R.N.A.S. Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy; 3 Ospedale Bellaria Maggiore, Bologna, Italy; 4 Istituto Clinico Humanitas, Rozzano, Milano, Italy Background and aim: EUS-FNA plays a central role in the diagnostic algorithm of solid pancreatic masses. Different needle diameters and the use of a stylet are not associated with differences in terms of diagnostic yield. Our aim was to compare EUS-FNA in the same solid pancreatic mass done with a 22-gauge needle with different aspiration volumes (20, 10, 0ml), looking for adequacy, diagnostic accuracy and, complications. Material and methods: Prospective clinical study at four referral centers. EUS was performed by five experienced echo-endoscopist. The needle was in all cases 22-gauge. We performed three punctures in the same mass with a 22-gauge needle at a volume aspiration of 20 and 10 cc, and without syringe. The sequence was randomly assigned. The cytopathologist was always blinded as to which aspiration was used for which specimen. Results: Eighty-eight patients with solid pancreatic masses were consecu-
Conclusions: Considering the significantly higher sensitivity and accuracy that we found with the 20ml aspiration puncture, we can conclude that performing all passes with this volume aspiration may largely improve cellular adequacy and the final diagnostic accuracy of FNA in solid pancreatic masses.
OC.17.4 FEASIBILITY AND DIAGNOSTIC YIELD OF A NEW EUS CITO-HISTOLOGIC NEEDLE IN COMPARISON WITH STANDARD EUS-FINE NEEDLE ASPIRATION: A 2-YEAR SINGLE-CENTRE EXPERIENCE C.G. De Angelis ∗ , S. Gaia, S.F. Manfrè, A. Andrealli, M. Bruno, P. Carucci, D. Pacchioni, A. Cassenti, R. Senetta, L. Molinaro, G. Gatti, A. Sapino, M. Rizzetto Città della Salute e della Scienza, Turin, Italy Background and aim: Fine Needle Aspiration (FNA) under EUS guidance is an efficient and safe method to obtain tissue samples from the GI tract and from the nearest structures. Whereas EUS-FNA provides samples of cells without any tissue structure information, EUS-Fine Needle Biopsy (FNB) has the theorethical advantage to collect tissue for histological evaluation. The aim of this study is to compare feasibility and diagnostic yield of the new FNB device (Cook EchoTip ProCore) with the standard FNA needles. Material and methods: 134 patients (75/59 M/F; 62±13.5 years) were consecutively enrolled between April 2011 and June 2013, for a total of 137 lesions (mean size 33.5±16 mm, range: 6–100 mm): 81 pancreas, 31 lymph nodes, 8 stomach, 7 gut (including 1 papilla), 4 esophagus, 5 aspecific abdominal masses, 1 nervous ganglia. For each lesion EUS-guided tissue sampling was performed both with standard needle and with ProCore needle. An expert cytopathologist evaluated the material assessing the feasibility of the diagnosis on the samples from the two types of needle. Results: A mean of 3.2±1.1 (range 1–6) and 2.8±1.1 (range 1–7) needle passes per lesion were performed with standard needles and ProCore respectively. A core sample adequate for histological assessment from ProCore biopsy was achieved in 29% lesions, 37% of lesions however fitted for cytological evaluation, whereas 34% were inadequate. A final diagnosis was reached 84% cases; 66% of the ProCore samples and 67% of the standard needle samples (p: ns; Standard Echo alone versus both: p 0.009; ProCore alone versus both: p 0.005). In 16.5% the diagnosis was reached only on the ProCore sample. No complications were observed. Conclusions: EUS-FNB is feasible and safe, but only in 29% of cases a core sample adequate for histological evaluation was obtained. The success rate in reaching the diagnosis is similar with standard needles and with ProCore