@GiJournal @SunilAminMD @GIE_Journal @TrieuMD @8pm @gutdoc33 @ealjahdli For @GIJournalClub
❇️@GIE_Journal article: Impact of EUS-guided MFB and nCLE on the diagnostic yield and clinical management of pancreatic cystic lesions.
🔸Expert Opinion: @gutdoc33 @ealjahdli
🔸Moderator: @SunilAminMD @TrieuMD @KM_Pawlak
#GIJC
giejournal.org/article/S0016-…
❇️@GIE_Journal article: Impact of EUS-guided MFB and nCLE on the diagnostic yield and clinical management of pancreatic cystic lesions.
🔸Expert Opinion: @gutdoc33 @ealjahdli
🔸Moderator: @SunilAminMD @TrieuMD @KM_Pawlak
#GIJC
giejournal.org/article/S0016-…
@GiJournal @SunilAminMD @GIE_Journal @TrieuMD @8pm @gutdoc33 @ealjahdli ❇️ Background
Pancreatic cystic lesions (PCLs)
🔹classified into simple retention cysts, pseudocysts and cystic neoplasms
🔹different malignant potential
🔹have varying demographic, morphological, histological and clinical characteristics
🔹various diagnostic modalities for PCL
Pancreatic cystic lesions (PCLs)
🔹classified into simple retention cysts, pseudocysts and cystic neoplasms
🔹different malignant potential
🔹have varying demographic, morphological, histological and clinical characteristics
🔹various diagnostic modalities for PCL
@GiJournal @SunilAminMD @GIE_Journal @TrieuMD @8pm @gutdoc33 @ealjahdli Differences between MFB and nCLE
#GIJC
#GIJC
@GiJournal @SunilAminMD @GIE_Journal @TrieuMD @8pm @gutdoc33 @ealjahdli @helpatologist @RodriguezParra_ @BilalMohammadMD @SultanMahmoodMD @drdalbir @SanchezLunaMD @RashidLui @drkeithsiau ❇️ Clinical question
❓Comparison of the diagnostic outcomes and changes in clinical management of PCLs❓
➡️ MFB and CLE vs. the standard evaluation of PCLs (clinical features, imaging findings, standard cyst fluid chemical and cytologic analysis)
#GIJC
❓Comparison of the diagnostic outcomes and changes in clinical management of PCLs❓
➡️ MFB and CLE vs. the standard evaluation of PCLs (clinical features, imaging findings, standard cyst fluid chemical and cytologic analysis)
#GIJC
@GiJournal @SunilAminMD @GIE_Journal @TrieuMD @8pm @gutdoc33 @ealjahdli @helpatologist @RodriguezParra_ @BilalMohammadMD @SultanMahmoodMD @drdalbir @SanchezLunaMD @RashidLui @drkeithsiau ❇️ Study design
🔹Single center retrospective design
🔹EUS-FNA, MFB, nCLE during same session
🔹PCLs characterized based on results of "composite standard" (imaging, fluid analysis, cytology, MFB, nCLE)
🔹Clinical management based on cyst type
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🔹Single center retrospective design
🔹EUS-FNA, MFB, nCLE during same session
🔹PCLs characterized based on results of "composite standard" (imaging, fluid analysis, cytology, MFB, nCLE)
🔹Clinical management based on cyst type
#GIJC
@GiJournal @SunilAminMD @GIE_Journal @TrieuMD @8pm @gutdoc33 @ealjahdli @helpatologist @RodriguezParra_ @BilalMohammadMD @SultanMahmoodMD @drdalbir @SanchezLunaMD @RashidLui @drkeithsiau ❇️Results
- Technical success: EUS-FNA (100%); MFB (88.6%); nCLE (97.7%)
- Diagnostic yield:CS (34.1%); MFB (75%, p<0.05 vs CS); nCLE (84.1%, p<0.05 vs CS)
- Diagnostic yield for combined tests: CS/MFB (79.5%); CS/nCLE (88.6%); CS/MFB/nCLE (93.2%)–no significant differences
#GIJC
- Technical success: EUS-FNA (100%); MFB (88.6%); nCLE (97.7%)
- Diagnostic yield:CS (34.1%); MFB (75%, p<0.05 vs CS); nCLE (84.1%, p<0.05 vs CS)
- Diagnostic yield for combined tests: CS/MFB (79.5%); CS/nCLE (88.6%); CS/MFB/nCLE (93.2%)–no significant differences
#GIJC
@GiJournal @SunilAminMD @GIE_Journal @TrieuMD @8pm @gutdoc33 @ealjahdli @helpatologist @RodriguezParra_ @BilalMohammadMD @SultanMahmoodMD @drdalbir @SanchezLunaMD @RashidLui @drkeithsiau ❇️ Results
Clinical management, compared to the CS:
- Discontinuation of surveillance: MFB (34.1%, p<0.05); nCLE (31.8%, p<0.05)
- Reduction in radiologic or endoscopic studies: (MFB (34.1%, p<0.05); nCLE (38.6%, p<0.05)
- Referral to surgery: MFB (7.1%); nCLE (10.7%)
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Clinical management, compared to the CS:
- Discontinuation of surveillance: MFB (34.1%, p<0.05); nCLE (31.8%, p<0.05)
- Reduction in radiologic or endoscopic studies: (MFB (34.1%, p<0.05); nCLE (38.6%, p<0.05)
- Referral to surgery: MFB (7.1%); nCLE (10.7%)
#GIJC
@GiJournal @SunilAminMD @GIE_Journal @TrieuMD @8pm @gutdoc33 @ealjahdli @helpatologist @RodriguezParra_ @BilalMohammadMD @SultanMahmoodMD @drdalbir @SanchezLunaMD @RashidLui @drkeithsiau @NasirSaleemMD ❇️ Limitations
-Few resections that allowed confirmation of PCL diagnosis with surgical pathology.
-Interobserver variability of nCLE.
-Frequent insertion/removal of devices from the needle channel decreased cyst size, decreasing fluid available for cyst fluid aspiration.
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-Few resections that allowed confirmation of PCL diagnosis with surgical pathology.
-Interobserver variability of nCLE.
-Frequent insertion/removal of devices from the needle channel decreased cyst size, decreasing fluid available for cyst fluid aspiration.
#GIJC
@GiJournal @SunilAminMD @GIE_Journal @TrieuMD @8pm @gutdoc33 @ealjahdli @helpatologist @RodriguezParra_ @BilalMohammadMD @SultanMahmoodMD @drdalbir @SanchezLunaMD @RashidLui @drkeithsiau @NasirSaleemMD ⚠️ Conclusion
Compared to current standard evaluation of PCLs, use of EUS-guided MFB and/or nCLE in the diagnostic evaluation results in significant improvement in obtaining a specific diagnosis and in changing clinical management of the PCL.
#GIJC
Compared to current standard evaluation of PCLs, use of EUS-guided MFB and/or nCLE in the diagnostic evaluation results in significant improvement in obtaining a specific diagnosis and in changing clinical management of the PCL.
#GIJC
@GiJournal @SunilAminMD @GIE_Journal @TrieuMD @8pm @gutdoc33 @ealjahdli @helpatologist @RodriguezParra_ @BilalMohammadMD @SultanMahmoodMD @drdalbir @SanchezLunaMD @RashidLui @drkeithsiau @NasirSaleemMD 🔮 Future direction
-Larger multi-center studies to evaluate safety and cost-effectiveness of these modalities.
#GIJC
-Larger multi-center studies to evaluate safety and cost-effectiveness of these modalities.
#GIJC
