Contrast-enhanced harmonic endoscopic ultrasound-guided fine-needle aspiration versus standard fine-needle aspiration in pancreatic masses: a meta-analysis

Objectives: It is still unclear whether endoscopic ultrasound (EUS) contrast-enhanced fine-needle aspiration (CH-EUS-FNA) determines superior results in comparison to standard EUS-FNA in tissue acquisition of pancreatic masses. Aim of this meta-analysis was to compare the diagnostic outcomes of these two techniques. Methods: We searched the PubMed/Medline and Embase database through October 2020 and identified 6 studies, of which 2 randomized controlled trials (recruiting 701 patients). We performed pairwise meta-analysis through a random effects model and expressed data as odds ratio (OR) and 95% confidence interval (CI). Results: Pooled diagnostic sensitivity was 84.6% (95% CI 80.7%-88.6%) with CH-EUS-FNA and 75.3% (67%-83.5%) with EUS-FNA, with evidence of a significant superiority of the former (OR 1.74, 95% CI 1.26–2.40; p < 0.001). Subgroup analysis confirmed the superiority of CH-EUS-FNA over EUS-FNA only in larger lesions. Pooled diagnostic accuracy was 88.8% (85.6%-91.9%) in CH-EUS-FNA group and 83.6% (79.4%-87.8%) in EUS-FNA group (OR 1.52, 1.01–2.31; p = 0.05). Pooled sample adequacy was 95.1% (91.1%-99.1%) with CH-EUS-FNA and 89.4% (81%-97.8%) with EUS-FNA (OR 2.40, 1.38–4.17; p = 0.02). Conclusion: CH-EUS-FNA seems to be superior to standard EUS-FNA in patients with pancreatic masses. Further trials are needed to confirm these results.