Influence of biliary stents on the diagnostic outcome of endoscopic ultrasound-guided tissue acquisition from solid pancreatic lesions: a systematic review and meta-analysis.

Background/aims: This meta-analysis analyzed the effect of an indwelling biliary stent on endoscopic ultrasound (EUS)-guided tissue acquisition from pancreatic lesions.

Methods: A literature search was performed to identify studies published between 2000 and July 2022 comparing the diagnostic outcomes of EUS-TA in patients with or without biliary stents. For non-strict criteria, samples reported as malignant or suspicious for malignancy were included, whereas for strict criteria, only samples reported as malignant were included in the analysis.

Results: Nine studies were included in this analysis. The odds of an accurate diagnosis were significantly lower in patients with indwelling stents using both non-strict (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.52-0.90) and strict criteria (OR, 0.58; 95% CI, 0.46-0.74). The pooled sensitivity with and without stents were similar (87% vs. 91%) using non-strict criteria. However, patients with stents had a lower pooled sensitivity (79% vs. 88%) when using strict criteria. The sample inadequacy rate was comparable between groups (OR, 1.12; 95% CI, 0.76-1.65). The diagnostic accuracy and sample inadequacy were comparable between plastic and metal biliary stents.

Conclusion: The presence of a biliary stent may negatively affect the diagnostic outcome of EUS-TA for pancreatic lesions.