Objective assessment of an algorithmic approach to EUS-guided FNA and interventions

BackgroundDespite an increasing number of procedures being performed, there is no consensus on an optimal approach to EUS-guided FNA (EUS-FNA) or interventions.ObjectiveValidate an algorithmic approach to EUS-FNA/interventions with the objective of improving technical outcomes and resource use.DesignProspective study.SettingTertiary-care referral center.PatientsConsecutive patients undergoing EUS-FNA and/or interventions.InterventionPhase 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 MeasurementsCompare technical failure, diagnostic adequacy, procedural complications, and average needle costs between both phases.ResultsThe 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).LimitationsSingle-center study.ConclusionAn algorithmic approach to EUS-FNA/interventions yielded better technical outcomes and cost savings without compromising diagnostic adequacy.