Does General Anesthesia Increase the Diagnostic Yield of Endoscopic Ultrasound-guided Fine Needle Aspiration of Pancreatic Masses?

: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of the pancreas has become the preferred method for tissue diagnosis for pancreatic solid masses. The yield of EUS-FNA in this setting is influenced by multiple factors. We hypothesized that general anesthesia (GA) may improve EUS-FNA y...

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Bibliographic Details
Published in:Anesthesiology (Philadelphia) 2012-11, Vol.117 (5), p.1044-1050
Main Authors: OOTAKI, Chiyo, STEVENS, Tyler, VARGO, John, JING YOU, SHIBA, Ayako, FOSS, Joseph, BORKOWSKI, Raymond, MAURER, Walter
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Anesthesia
Anesthesia, General - methods
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Cohort Studies
Endoscopic Ultrasound-Guided Fine Needle Aspiration - methods
Female
Humans
Male
Medical sciences
Middle Aged
Pancreatic Neoplasms - diagnosis
Pancreatic Neoplasms - epidemiology
Retrospective Studies
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Summary:: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of the pancreas has become the preferred method for tissue diagnosis for pancreatic solid masses. The yield of EUS-FNA in this setting is influenced by multiple factors. We hypothesized that general anesthesia (GA) may improve EUS-FNA yield by improving patient cooperation and stillness during the procedure. Our objective was to assess the association between the sedation method employed and the diagnostic yield of EUS-FNA. : A retrospective cohort study was conducted involving consecutive patients who received EUS-FNA for diagnosis of a solid pancreatic mass at the Cleveland Clinic (Cleveland, OH) gastrointestinal endoscopy units from 2007 to 2009. We compared the diagnostic yield of EUS-FNA between patients receiving GA provided by an anesthesiologist (GA group) and patients receiving conscious sedation (CS) provided by a qualified registered nurse (CS group). : Of 371 patients, a cytological diagnosis was obtained in 73/88 patients (83%) in the GA group and 206/283 patients (73%) in the CS group. Anesthesiologist-delivered GA was associated with an increased odds of having a successful diagnosis as compared with CS (adjusted odds ratio [95% CI]: 2.56 [1.27-5.17], P = 0.01). However, the incidence of complication during or after the procedure was not different between the groups (P > 0.99). : Anesthesiologist-delivered GA was associated with a significantly higher diagnostic yield of EUS-FNA. GA should be considered a preferred sedation method for EUS-FNA of a solid pancreatic mass.
ISSN:0003-3022
1528-1175
DOI:10.1097/ALN.0b013e31826e0590