Clin Endosc.  2020 Jul;53(4):417-428. 10.5946/ce.2019.053.

Endoscopic Ultrasound-Guided Fine Needle Aspiration and Endoscopic Retrograde Cholangiopancreatography-Based Tissue Sampling in Suspected Malignant Biliary Strictures: A Meta-Analysis of Same-Session Procedures

• de Moura DTH
• Ryou M
• de Moura EGH
• Ribeiro IB
• Bernardo WM
• Thompson CC

• KMID: 2504945
• DOI: http://doi.org/10.5946/ce.2019.053

Abstract

Background/Aims
The diagnosis of biliary strictures can be challenging. There are no systematic reviews studying same-session endoscopic retrograde cholangiopancreatography (ERCP)-based tissue sampling and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for the diagnosis of biliary strictures.
Methods
A systematic review was conducted on studies analyzing same-session EUS and ERCP for tissue diagnosis of suspected malignant biliary strictures. The primary outcome was the accuracy of each method individually compared to the two methods combined. The secondary outcome was the accuracy of each method in pancreatic and biliary etiologies. In the meta-analysis, we used Forest plots, summary receiver operating characteristic curves, and estimates of the area under the curve for intention-to-treat analysis.
Results
Of the 12,132 articles identified, six were included, resulting in a total of 497 patients analyzed. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and accuracy of the association between the two methods were: 86%, 98%, 12.50, 0.17, and 96.5%, respectively. For the individual analysis, the sensitivity, specificity and accuracy of EUS-FNA were 76%, 100%, and 94.5%, respectively; for ERCP-based tissue sampling, the sensitivity, specificity, and accuracy were 58%, 98%, and 78.1%, respectively. For pancreatic lesions, EUS-FNA was superior to ERCP-based tissue sampling. However, for biliary lesions, both methods had similar sensitivities.
Conclusions
Same-session EUS-FNA and ERCP-based tissue sampling is superior to either method alone in the diagnosis of suspected malignant biliary strictures. Considering these results, combination sampling should be performed when possible.

Keyword

Endoscopy; Endoscopic retrograde cholangiopancreatography; Endoscopic ultrasound; Cancer; Diagnosis

Figure

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  Fig. 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.

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  Fig. 2. Forest plots of the sensitivity, specificity, positive likelihood ratio (LR) and negative LR of the association of endoscopic ultrasound-guided fine needle aspiration and endoscopic retrograde cholangiopancreatography-based tissue sampling in the diagnosis of suspected malignant biliary strictures. CI, confidence interval.

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  Fig. 3. Summary receiver operating characteristic (sROC) curve of the association of endoscopic ultrasound-guided fine needle aspiration and endoscopic retrograde cholangiopancreatography-based tissue sampling in the diagnosis of suspected malignant biliary strictures. AUC, area under the curve; SE, standard error.

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  Fig. 4. Forest plots of the sensitivity, specificity, positive likelihood ratio (LR) and negative LR of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of suspected malignant biliary strictures. CI, confidence interval.

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  Fig. 5. Forest plots of the sensitivity, specificity, positive likelihood ratio (LR) and negative LR of endoscopic retrograde cholangiopancreatography-based tissue sampling in the diagnosis of suspected malignant biliary strictures. CI, confidence interval.

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  Fig. 6. Forest plots of the sensitivity, specificity, positive likelihood ratio (LR) and negative LR of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of pancreatic lesion causing biliary strictures. CI, confidence interval.

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  Fig. 7. Forest plots of the sensitivity, specificity, positive likelihood ratio (LR) and negative LR of endoscopic retrograde cholangiopancreatography in the diagnosis of pancreatic lesion causing biliary strictures. CI, confidence interval.

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  Fig. 8. Forest plots of the sensitivity, specificity, positive likelihood ratio (LR) and negative LR of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of biliary lesions. CI, confidence interval.

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  Fig. 9. Forest plots of the sensitivity, specificity, positive likelihood ratio (LR) and negative LR of endoscopic retrograde cholangiopancreatography-based tissue sampling in the diagnosis of biliary lesions. CI, confidence interval.

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