P4484 - Stereomicroscopic On-Site Evaluation in Endoscopic Ultrasound-Guided Tissue Acquisition of Upper GI and Pancreatic Lesions: A Systematic Review and Meta-Analysis

Fouad Jaber, MD, MS¹, Mohammad Jaber, MD², Saqr Alsakarneh, MD¹, Ahmed Fares, MD³, Tala Alsharaeh, MD⁴, Ahmed-Jordan Salahat, MD⁴, Mohammed Ayyad, MD⁵, Yazan Sallam, MD⁶, Anas Alselek, MD⁷, Raed Darwish, MD⁸, Laith Numan, MD, MS⁹, Wasseem Skef, MD¹⁰, Shifa Umar, MD^10
1University of Missouri - Kansas City School of Medicine, Kansas City, MO; ²Al-Azhar University, Gaza, Palestinian Territories; ³Tufts Medical Center, Boston, MA; ⁴The University of Jordan, Amman, 'Amman, Jordan; ⁵Rutgers New Jersey Medical School, Newark, NJ; ⁶University of Missouri, Kansas City, MO; ⁷Cairo University School of Medicine, Cairo, Al Jizah, Egypt; ⁸Ain Shams University, Cairo, Al Qahirah, Egypt; ⁹Saint Louis University, St. Louis, MO; ¹⁰Baylor College of Medicine, Houston, TX

Introduction: Macroscopic on-site evaluation (MOSE) during endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) shows promise, yet a standardized approach remains elusive. Stereomicroscopic on-site evaluation (SOSE), which assesses EUS-guided tissue acquisition (EUS-TA) quality by detecting stereomicroscopically visible white cores (SVWC) ≥4 mm, has shown high diagnostic sensitivity in limited studies. This systematic review evaluates SOSE's efficacy in enhancing diagnostic accuracy during EUS-TA of upper gastrointestinal subepithelial lesions (SELs) and pancreatic lesions (PLs).

Methods: A systematic literature review was conducted across Cochrane, SCOPUS, PubMed, and EMBASE from inception to March 2024. Studies evaluating SOSE for diagnosing gastrointestinal and PLs via EUS- fine-needle aspiration (FNA) or FNB were included. Primary outcomes included sensitivity, specificity, and diagnostic accuracy. Secondary outcomes included positive predictive value (PPV), negative predictive value (NPV), tissue sampling rate, and adverse events. The pooled analysis utilized random effects models and heterogeneity was interpreted using I² statistics.

Results: Six studies involving 368 patients were analyzed, with most lesions being PLs (57.3%) and SELs (41%). All studies used 22-gauge needles for EUS-TA, with four studies using fine-needle biopsy (FNB) and two using both FNB and FNA. The pooled sensitivity, specificity, and accuracy of SOSE were 95.6%, 96.4%, and 93.5%, respectively (Figure 1). The pooled diagnostic accuracy, PPV, and NPV were 91.9%, 97.5%, and 86.7%. The pooled rate for obtaining microscopic tissue cells/tissue fragments per lesion was 96.2% (confidence interval [CI]: 77%-99.5%), and per pass was 93.5% (CI: 89%-96.2%)(Table 1). The pooled tissue sampling rate per lesion and per pass was 99% (CI: 96.5%-99.7%) and 93.7% (CI: 88.2%-96.7%), respectively (Table 1). The pooled rate for achieving the presence of SVWC per lesion was 98.9% (CI: 96.6%-99.6%) and per pass was 95.6% (CI: 91.3%-97.8%). The only reported adverse events across all studies were cases of bleeding, with a pooled rate of 3% (CI: 1.4%-6.2%) (Table 1).

Discussion: Our analysis highlights the efficacy of SOSE in improving diagnostic outcomes of SELs and PLs during EUS-TA. With its high diagnostic sensitivity, SOSE emerges as a viable alternative, particularly beneficial for accurate pathological diagnosis of pancreatic and subepithelial lesions in settings lacking rapid on-site evaluation (ROSE) capabilities.



Disclosures:


Fouad Jaber, MD, MS¹, Mohammad Jaber, MD², Saqr Alsakarneh, MD¹, Ahmed Fares, MD³, Tala Alsharaeh, MD⁴, Ahmed-Jordan Salahat, MD⁴, Mohammed Ayyad, MD⁵, Yazan Sallam, MD⁶, Anas Alselek, MD⁷, Raed Darwish, MD⁸, Laith Numan, MD, MS⁹, Wasseem Skef, MD¹⁰, Shifa Umar, MD¹⁰. P4484 - Stereomicroscopic On-Site Evaluation in Endoscopic Ultrasound-Guided Tissue Acquisition of Upper GI and Pancreatic Lesions: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.