TY - JOUR

T1 - Predictors of adverse events after endoscopic ultrasound-guided through-the-needle biopsy of pancreatic cysts

T2 - A recursive partitioning analysis

AU - Facciorusso, Antonio

AU - Kovacevic, Bojan

AU - Yang, Dennis

AU - Vilas-Boas, Filipe

AU - Martínez-Moreno, Belén

AU - Stigliano, Serena

AU - Rizzatti, Gianenrico

AU - Sacco, Marco

AU - Arevalo-Mora, Martha

AU - Villarreal-Sanchez, Leonardo

AU - Conti Bellocchi, Maria Cristina

AU - Bernardoni, Laura

AU - Gabbrielli, Armando

AU - Barresi, Luca

AU - Gkolfakis, Paraskevas

AU - Robles-Medranda, Carlos

AU - De Angelis, Claudio

AU - Larghi, Alberto

AU - Di Matteo, Francesco Maria

AU - Aparicio, José R.

AU - Macedo, Guilherme

AU - Draganov, Peter V.

AU - Vilmann, Peter

AU - Pecchia, Leandro

AU - Repici, Alessandro

AU - Crinò, Stefano Francesco

N1 - Publisher Copyright: © 2022 Georg Thieme Verlag. All rights reserved.

PY - 2022

Y1 - 2022

N2 - Background and study aims Endoscopic ultrasoundguided through-the-needle biopsy (TTNB) of pancreatic cystic lesions (PCLs) is associated with a non-negligible risk for adverse events (AEs). We aimed to identify the hierarchic interaction among independent predictors for TTNBrelated AEs and to generate a prognostic model using recursive partitioning analysis (RPA). Patients and methods Multicenter retrospective analysis of 506 patients with PCLs who underwent TTNB. RPA of predictors for AEs was performed and the model was validated by means of bootstrap resampling. Results Mean cysts size was 36.7mm. Most common diagnoses were intraductal papillary mucinous neoplasm (IPMN, 45 %), serous cystadenoma (18.8 %), and mucinous cystadenoma (12.8 %). Fifty-eight (11.5%) AEs were observed. At multivariate analysis, age (odds ratio [OR] 1.32, 1.09-2.14; p = 0.05), number of TTNB passes (OR from 2.17, 1.32-4.34 to OR 3.16, 2.03-6.34 with the increase of the number of passes), complete aspiration of the cyst (OR 0.56, 0.31-0.95; p = 0.02), and diagnosis of IPMN (OR 4.16, 2.27-7.69; p < 0.001) were found to be independent predictors of AEs, as confirmed by logistic regression and random forest analyses. RPA identified three risk classes: high-risk (IPMN sampled with multiple microforceps passes, 28% AEs rate), low-risk (1.4% AE rate, including patients < 64 years with other-than-IPMN diagnosis sampled with ≤ 2 microforceps passes and with complete aspiration of the cyst) and middle-risk class (6.1% AEs rate, including the remaining patients). Conclusion TTNB should be selectively used in the evaluation of patients with IPMN. The present model could be applied during patient selection as to optimize the benefit/risk of TTNB.

AB - Background and study aims Endoscopic ultrasoundguided through-the-needle biopsy (TTNB) of pancreatic cystic lesions (PCLs) is associated with a non-negligible risk for adverse events (AEs). We aimed to identify the hierarchic interaction among independent predictors for TTNBrelated AEs and to generate a prognostic model using recursive partitioning analysis (RPA). Patients and methods Multicenter retrospective analysis of 506 patients with PCLs who underwent TTNB. RPA of predictors for AEs was performed and the model was validated by means of bootstrap resampling. Results Mean cysts size was 36.7mm. Most common diagnoses were intraductal papillary mucinous neoplasm (IPMN, 45 %), serous cystadenoma (18.8 %), and mucinous cystadenoma (12.8 %). Fifty-eight (11.5%) AEs were observed. At multivariate analysis, age (odds ratio [OR] 1.32, 1.09-2.14; p = 0.05), number of TTNB passes (OR from 2.17, 1.32-4.34 to OR 3.16, 2.03-6.34 with the increase of the number of passes), complete aspiration of the cyst (OR 0.56, 0.31-0.95; p = 0.02), and diagnosis of IPMN (OR 4.16, 2.27-7.69; p < 0.001) were found to be independent predictors of AEs, as confirmed by logistic regression and random forest analyses. RPA identified three risk classes: high-risk (IPMN sampled with multiple microforceps passes, 28% AEs rate), low-risk (1.4% AE rate, including patients < 64 years with other-than-IPMN diagnosis sampled with ≤ 2 microforceps passes and with complete aspiration of the cyst) and middle-risk class (6.1% AEs rate, including the remaining patients). Conclusion TTNB should be selectively used in the evaluation of patients with IPMN. The present model could be applied during patient selection as to optimize the benefit/risk of TTNB.

U2 - 10.1055/a-1831-5385

DO - 10.1055/a-1831-5385

M3 - Journal article

C2 - 35451041

AN - SCOPUS:85134026903

VL - 54

SP - 1158

EP - 1168

JO - Endoscopy

JF - Endoscopy

SN - 0013-726X

IS - 12

ER -