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ABSTRACTS: ACCEPTED: BILIARY/PANCREAS

Diagnostic Yield of Micro Forceps Biopsies during Endoscopic Ultrasound Evaluation of Pancreatic Cystic Lesions

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Mittal, Chetan MD1; Obuch, Joshua MD, MSCS1; Wani, Sachin MD2; Edmundowicz, Steven MD2; Shah, Raj MD2; Brauer, Brian MD2; Hammad, Hazem MD2; Attwell, Augustin MD3; Wagh, Mihir S. MD1

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American Journal of Gastroenterology: October 2017 - Volume 112 - Issue - p S31
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Introduction: Evaluation of pancreatic cystic lesions (PCLs) can be challenging and requires a combination of radiologic imaging, morphologic characteristics on endoscopic ultrasound (EUS), cyst fluid cytology, and cyst fluid analysis. Through-the-needle micro forceps (Moray micro forceps, US Endoscopy, Mentor, OH) are a recent addition to EUS armamentarium. These forceps allow tissue sampling from PCLs and may improve diagnostic yield. To date, scant data exists on the use of micro forceps biopsy for these lesions. The main aim of this study was to assess diagnostic yield and safety of EUS-guided micro forceps biopsy for PCLs.

Methods: Our electronic endoscopy database was queried to identify patients who underwent EUS-FNA of PCLs and biopsies with the micro forceps, during the same procedure. Cysts were identified on EUS and punctured using 19-G FNA needle. All patients received peri-procedural antibiotics. Cyst fluid was collected for cytologic analysis, CEA and amylase levels, and wall of the cyst was biopsied using micro forceps through the 19-G needle. Adverse events were recorded per published ASGE criteria.

Results: Twenty patients (mean age 64.2 years [range 34 -87]; 8/20 male [40%]) underwent EUS-FNA and micro-forceps biopsy of PCLs from 02/2016 to 05/2017. The mean cyst size was 34.4 mm (range 13 -70 mm), with 10 cysts in the pancreatic head/uncinate and 10 in the body/tail region. Micro forceps biopsies were technically successful in all cases, and provided a diagnosis of neoplasia in 11 cases (55%), benign tissue in 8 cases (40%) and insufficient quantity in 1 case. In 4 patients (20%), micro forceps biopsy results drastically changed patient management, providing diagnoses (1 Neuroendocrine tumor, 1 mucinous cystic neoplasm, and 2 IPMNs) otherwise not suggested by cytology or cyst fluid analysis. However, cytology provided a diagnosis of mucinous neoplasm in 3 cases not detected by micro forceps biopsies. No adverse events were noted.

Conclusion: Micro forceps biopsies were associated with high yield and excellent safety profile. Biopsies provided a diagnosis of neoplasia not detected by cytology in a significant number of patients but also did not identify mucinous neoplasms in a few cases as suggested by cyst fluid cytology. Hence micro forceps biopsies may be a useful adjunctive tool for EUS guided assessment of PCLs, complementing existing EUS-FNA sampling protocols.

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