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Background and Aim: While encouraging data of endoscopic ultrasound (EUS)‐guided fine‐needle biopsy (EUS‐FNB) using a 22‐gauge Franseen needle have been reported, large‐scale data of per pass and quantitative analyses are still lacking. Methods: This was a multicenter prospective study of EUS‐FNB using the 22‐gauge Franseen needle for a pancreatic solid lesion. Cytological and histological analyses per pass were evaluated and semi‐quantitative analyses were performed on core tissue and blood contamination. Primary end‐point was diagnostic accuracy per session. Prognostic factors were analyzed for diagnostic accuracy, sensitivity, core tissue, and blood contamination. Results: A total of 629 passes were performed in 244 cases at 14 centers between 2018 and 2019. The median tumor size was 29 mm, and the puncture was transduodenal in 43%. The median pass number was 2. Diagnostic accuracy per session, at a first pass, and per pass were 93%, 90%, and 88%. In 198 cases with pancreatic cancer, diagnostic sensitivity per session, at a first pass, and per pass were 94%, 89%, and 89%. The rates of core tissue score of 4 and blood contamination score of 3 were 50% and 47%. The adverse event rate was 1.6%. In the multivariate analysis, tumor size ≤20 mm (odds ratio [OR] of 0.46, P = 0.03), transduodenal puncture (OR of 0.53, P = 0.04), and suction (OR of 0.16, P = 0.01) were associated with lower diagnostic accuracy. Conclusions: The EUS‐FNB using the 22‐gauge Franseen needle for pancreatic solid lesions showed high per pass and overall diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Severe acute pancreatitis (SAP) has a high mortality rate despite ongoing attempts to improve prognosis through a various therapeutic modalities. This study aimed to delineate etiology-based routes that may guide clinical decisions for the treatment of SAP. Using data from a recent retrospective multicenter study in Japan, we analyzed the association between clinical outcomes, mainly in-hospital mortality and pancreatic infection, and various etiologies while considering confounding factors. We performed additional multivariate analyses and built decision tree models. The 1097 participating patients were classified into the following groups by etiology: alcohol (n = 436, 39.7%); cholelithiasis (n = 230, 21.0%); idiopathic (n = 227, 20.7%); and others (n = 204, 18.6%). Mortality at hospital discharge was 8.4%, 12.2%, 16.7%, and 16.2% in the alcohol, cholelithiasis, idiopathic, and others groups, respectively. According to multivariable analysis, early enteral nutrition (EN) was significantly associated with reduced in-hospital mortality only in the cholelithiasis group. However, there was a consistent association between age and the need for mechanical ventilation and increased mortality, regardless of etiology. Our decision tree models presented different contributing factors depending on the etiology and patient background. Interaction analysis showed that EN and the use of prophylactic antibiotics may influence these results differently according to etiology. No study has yet used comprehensive models to investigate etiology-related prognostic factors for SAP; our results can, therefore, be used as a reference for improving clinical decisions. [ABSTRACT FROM AUTHOR]

Abstract: Background and Aim: Endoscopic nasobiliary drainage (ENBD) is often recommended in preoperative biliary drainage (PBD) for hilar malignant biliary obstruction (MBO), but endoscopic biliary stent (EBS) is also used in the clinical practice. We conducted this large‐scale multicenter study to compare ENBD and EBS in this setting. Methods: A total of 374 cases undergoing PBD including 281 ENBD and 76 EBS for hilar MBO in 29 centers were retrospectively studied. Results: Extrahepatic cholangiocarcinoma (ECC) accounted for 69.8% and Bismuth–Corlette classification was III or more in 58.8% of the study population. Endoscopic PBD was technically successful in 94.6%, and adverse event rate was 21.9%. The rate of post‐endoscopic retrograde cholangiopancreatography pancreatitis was 16.0%, and non‐endoscopic sphincterotomy was the only risk factor (odds ratio [OR] 2.51). Preoperative re‐intervention was performed in 61.5%: planned re‐interventions in 48.4% and unplanned re‐interventions in 31.0%. Percutaneous transhepatic biliary drainage was placed in 6.4% at the time of surgery. The risk factors for unplanned procedures were ECC (OR 2.64) and total bilirubin ≥ 10 mg/dL (OR 2.18). In surgically resected cases, prognostic factors were ECC (hazard ratio [HR] 0.57), predraiange magnetic resonance cholangiopancreatography (HR 1.62) and unplanned re‐interventions (HR 1.81). EBS was not associated with increased adverse events, unplanned re‐interventions, or a poor prognosis. Conclusions: Our retrospective analysis did not demonstrate the advantage of ENBD over EBS as the initial PBD for resectable hilar MBO. Although the technical success rate of endoscopic PBD was high, its re‐intervention rate was not negligible, and unplanned re‐intervention was associated with a poor prognosis in resected hilar MBO. [ABSTRACT FROM AUTHOR]