Objective assessment of an algorithmic approach to EUS-guided FNA and interventions.
Gastrointest Endosc
; 77(5): 739-44, 2013 May.
Article
en En
| MEDLINE
| ID: mdl-23369651
ABSTRACT
BACKGROUND:
Despite an increasing number of procedures being performed, there is no consensus on an optimal approach to EUS-guided FNA (EUS-FNA) or interventions.OBJECTIVE:
Validate an algorithmic approach to EUS-FNA/interventions with the objective of improving technical outcomes and resource use.DESIGN:
Prospective study.SETTING:
Tertiary-care referral center. PATIENTS Consecutive patients undergoing EUS-FNA and/or interventions. INTERVENTION Phase I was a retrospective analysis of EUS-FNA/interventions performed in 548 patients. The 19-gauge needle was used for interventions, and the 22- or 25-gauge needle was used interchangeably for performing FNAs. At phase I, the technical failure rate was 11.5%. Based on these observations, an algorithm was proposed by which all transduodenal FNAs were performed by using a 25-gauge needle and other FNAs with a 22-gauge needle. All transduodenal interventions were performed with a Flexible 19-gauge needle and others with a standard 19-gauge needle. This algorithm was tested prospectively in phase II on 500 patients. MAIN OUTCOME MEASUREMENTS Compare technical failure, diagnostic adequacy, procedural complications, and average needle costs between both phases.RESULTS:
The technical failure rate was significantly less in phase II compared with that of phase I (1.6% vs 11.5%; P < .001) for both FNA (1.8% vs 10.9%; P < .001) and therapeutic interventions (0% vs 16.4%; P = .001). Although there was no difference in diagnostic adequacy (97.1% vs 98.4%; P = .191) or complications (0.4% vs 0.2%; P = 1.0) between phases I and II, the average cost per case was significantly less in phase II ($199.59 vs $188.30; P = .008).LIMITATIONS:
Single-center study.CONCLUSION:
An algorithmic approach to EUS-FNA/interventions yielded better technical outcomes and cost savings without compromising diagnostic adequacy.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Algoritmos
/
Ultrasonografía Intervencional
/
Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico
Tipo de estudio:
Clinical_trials
/
Observational_studies
Límite:
Adolescent
/
Adult
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Aged
/
Aged80
/
Child
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Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Gastrointest Endosc
Año:
2013
Tipo del documento:
Article
País de afiliación:
Estados Unidos