Pancreatic Cancer Clinical Trial
Official title:
Intermittent Versus Continuous Suction Technique in the Diagnosis of Pancreatic Solid Lesions. A Pilot Study.
The aim of this study is to compare the diagnostic yield of intermittent versus continuous suction in the diagnosis of pancreatic solid lesions.
Solid lesions of the pancreas can be neoplastic or non neoplastic and it is important to
accurately differentiate between them because of the poor prognosis related to pancreatic
neoplasm. There are many types of solid pancreatic lesions: pancreatic adenocarcinoma,
neuroendocrine tumor, lymphoma, solid pseudopapillary neoplasm and pancreatic metastasis.
There are several diagnostic methods for the study of pancreatic solid lesions. The different
imaging test allow detection and characterization of those lesions, but most times an
anatomopathological diagnosis is needed before stablishing the most appropriate treatment.
Endoscopic Ultrasound guided fine needle aspiration (EUS-FNA) is the diagnostic method of
choice for the diagnosis of these lesions as it detects small lesions that sometimes cannot
be found in radiological imaging test, evaluates vascular invasion and the presence of liver
metastasis, and allows pancreatic puncture for a cytological diagnosis. EUS-FNA is the safest
technique for pancreatic puncture and the least related to needle track seeding.
In order to gather as much material as possible different techniques have been proposed:
- Fanning technique and multiple pass technique: to guide the needle into different
regions of the target lesions with or without removing the needle out of the lesion
depending on wether the lesion is hard or soft.
- Use of stylet: there are no data clearly demonstrating that the use of suction increases
the yield of EUS-FNA. Some authors do slow withdrawal of the stylet.
- Size of the needle: 19 gauge, 22 gauge, 25 gauge, depending on the localization, size
and vascularization. There is increasing evidence that smaller needles offer at least
similar results in diagnostic yield compared to larger needles and are also easier to
manipulate.
- Use of suction: there is conflicting evidence in this point. Several studies have
evaluated the use of high volume aspiration vs low volume aspiration, continous
aspiration vs no aspiration and suction with empty syringe vs water-filled syringe but
none is clearly better than other.
The investigators aim is to evaluate if the use of intermittent suction improves the
diagnostic yield of pancreatic lesions compared to standard (continuous) suction. Up to our
knowledge this method has not been yet evaluated.
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