Pancreatitis rare after EUS-guided fine-needle aspiration

Pancreatitis seldom occurs following endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) of pancreatic cystic lesions, but when it does, the severity is usually mild, with no cases of death.

“Most cases of EUS-FNA-related pancreatitis were mild and self-limiting with no reported mortality,” the authors said.

A systematic search was conducted in four databases from inception to April 2024. Original English-language studies examining EUS-FNA‒related pancreatitis were identified. The authors then extracted data on demographics and EUS-FNA‒related pancreatitis risk, severity, and risk factors.

The DerSimonian Laird Method was used in the meta-analysis via a random-effects model. The associations with clinical and procedural characteristics were delineated by performing meta-regression of the pancreatitis risk.

Sixty-four studies involving 8,086 patients met the eligibility criteria. A total of 110 pancreatitis events associated with EUS-FNA were reported. [Am J Gastroenterol 2024;119:2174-2186]

The pooled risk of pancreatitis related to EUS-FNA was low (1.4 percent, 95 percent confidence interval [CI], ‒0.8 to 3.5; I², 0.00). Most of the pancreatitis events were mild (67 percent) in severity and not fatal.

The risk of pancreatitis did not show a significant association with sample size, age, sex, cyst size, needle calibre, or passes. However, a trend toward an increased risk was seen in studies published after 2015, those using higher gauge needles (19 vs 22/25 G), and those performing EUS-guided through-the-needle biopsy (EUS-TTNB).

“EUS-TTNB may serve as a significant risk factor for EUS-FNA-related pancreatitis risk; however, further studies are needed to delineate other predisposing characteristics,” the authors said.

Higher prevalence

Interestingly, the risk of EUS-FNA‒related pancreatitis seen in this study is higher than that seen in a 2011 systematic review that featured 909 pancreatic cystic lesions (1.4 percent vs 0.44 percent). The current pooled risk was also higher than a previous review reporting 0.92 percent across 40 studies published through 2015. [Dig Endosc 2017;29:667-675; Gastrointest Endosc 2011;73:283-290]

“The present systematic review overcomes prior limitations by assessing the association of EUS-FNA‒related pancreatitis with clinically relevant covariates, synthesizing evidence from a sample size of 8,086 patients, and being the first to include 35 studies published after 2015,” the authors said.

“We also noted a higher prevalence of complicated pancreatitis than prior studies: severe pancreatitis was noted in 15.5 percent of cases in our study compared with only 8.3 percent in the study of Wang et al.; Zhu et al did not report on severity,” they added.

Advancements

In addition, the current study also explored the impact of advancements in EUS-FNA approaches that may overcome the diagnostic limitations of cytology and cyst fluid analysis alone. [Dig Endosc 2020;32:1018-1030; Endosc Int Open 2020;8:e656-e667]

“However, these adjunctive techniques, which generally require larger needles (19-gauge) and prolonged procedure times, may elevate pancreatitis risk as seen in prior estimates of adverse event rates in EUS-TTNB ranging from 7 percent to 8.6 percent with pancreatitis being one of the most common,” the authors said. [Endoscopy 2021;53:44-52]