Background and study aims There is limited evidence on the diagnostic performance of endoscopic ultrasound (EUS)-guided tissue acquisition in autoimmune pancreatitis (AIP). The aim of this meta-analysis was to provide a pooled estimate of the diagnostic performance of EUS-guided fine-needle aspiration (FNA) and fine-needle biopsy (FNB) in patients with AIP. Patients and methods Computerized bibliographic search was performed through January 2020. Pooled effects were calculated using a random-effects model by means of DerSimonian and Laird test. Primary endpoint was diagnostic accuracy compared to clinical diagnostic criteria. Additional outcomes were definitive histopathology, pooled rates of adequate material for histological diagnosis, sample adequacy, mean number of needle passes. Diagnostic sensitivity and safety data were also analyzed. Results Fifteen studies with 631 patients were included, of which four were prospective series and one randomized trial. Overall diagnostic accuracy of EUS tissue acquisition was 54.7 % (95 % confidence interval, 40.9 %–68.4 %), with a clear superiority of FNB over FNA (63 %, 52.7 % to 73.4 % versus 45.7 %, 26.5 %–65 %; p  Conclusion The results of this meta-analysis demonstrate that the diagnostic performance of EUS-guided tissue acquisition is modest in patients with AIP, with an improved performance of FNB compared to FNA.

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Diagnostic yield of endoscopic ultrasound-guided tissue acquisition in autoimmune pancreatitis: a systematic review and meta-analysis

Abstract Background Spontaneous intracerebral hemorrhage (ICH) with large hematomas is commonly treated with craniotomy combined with decompressive craniectomy, procedures that involve huge trauma and require subsequent cranioplasty. Recently, endoscopic surgery has shown significant promise in treating ICH, but its feasibility for large hematomas remains uncertain. Therefore, this study aims to compare endoscopic surgery with craniotomy and to evaluate the efficacy and safety of endoscopic surgery in treating large hematomas ICH. Methods A retrospective analysis was conducted on the clinical data from patients with spontaneous supratentorial ICH and hematoma volumes exceeding 50 mL who underwent either endoscopic surgery or craniotomy. Propensity score matching analysis was employed to reduce selection bias. The efficacy and safety of endoscopic surgery were evaluated by analyzing blood loss, postoperative edema, mortality rate, complications, and the Glasgow Outcome Scale (GOS) at 6-month follow-up. Results A total of 113 cases that met the criteria were collected, with 65 in the endoscopic surgery group and 48 in the craniotomy group. After propensity score matching, each group contained 34 cases. The mean hematoma volume was 64.84 ± 11.02 mL in the endoscopy group and 66.57 ± 12.77 mL in the craniotomy group ( p = 0.554). Hematoma evacuation rates were 93.27% in the endoscopy group and 89.34% in the craniotomy group ( p = 0.141). The endoscopy group exhibited lower blood loss, shorter surgical time, and reduced postoperative edema volume at 24 h compared to the craniotomy group. The rate of pulmonary infection was slightly lower in the endoscopy group compared to the craniotomy group (70.59% vs. 91.18%, p = 0.031), but there were no statistically significant differences in overall complications and mortality rate between the two groups. GOS scores were similar in both groups at the 6-month follow-up. Conclusions Endoscopic surgery is safe and feasible for treating spontaneous supratentorial ICH with large hematomas, demonstrating efficacy similar to that of craniotomy with decompressive craniectomy. 

Feasibility Study of Endoscopic Surgery for Spontaneous Intracerebral Hemorrhage with Large Hematoma: a Comparison with Craniotomy Using Propensity Score Matching Analysis

ABSTRACT Objectives There is limited evidence on the diagnostic yield of endoscopic ultrasound (EUS)‐guided tissue acquisition (TA) using fine‐needle biopsy (FNB) in autoimmune pancreatitis (AIP), particularly considering the newer end‐cutting needles. The aim of this meta‐analysis was to provide a pooled estimate of the diagnostic performance of EUS‐TA using FNB in AIP patients according to the needle type used. Methods A computerized bibliographic search was performed through April 2024. Pooled effects were calculated using a random‐effects model. The primary endpoint was diagnostic accuracy. Secondary outcomes were sample adequacy, rates of adequate material for levels 1 and 2 of histological diagnosis, definitive diagnosis reached with histology in addition to imaging/laboratory tests, and safety. Results Twelve studies (three prospective series and one randomized trial) with 496 patients were included. Overall diagnostic accuracy rate was 75% (66%–83%), with a superiority of end‐cutting needles over reverse bevel needles (80%, 70%–90% versus 49%, 21%–67%; p &lt; 0.001). Franseen (81%, 68%–93%) and Fork‐tip needles (86%, 74%–98%) showed the highest accuracy. Sample adequacy rate was 92% (87%–98%), and EUS‐TA using FNB provided level 1 of histological diagnosis in 47% of cases (38%–57%) and level 2 in 23% (16%–30%). EUS‐TA using FNB provided a definitive diagnosis in 77% (63%–91%) of cases. Pooled rate of adverse event was 2% (1%–3%), mainly mild pancreatitis. Conclusions End‐cutting needles showed high diagnostic yield in patients with AIP, with a low rate of adverse events, and should be preferred over reverse bevel needles. 

Endoscopic Ultrasound‐guided Fine‐Needle Biopsy With End‐Cutting Needles in Autoimmune Pancreatitis: A Systematic Review and Meta‐Analysis

Mo1343 SMALL-CALIBER EUS-GUIDED CORE BIOPSY NEEDLES ARE A SAFE AND EFFECTIVE MEANS TO DIAGNOSE AUTOIMMUNE PANCREATITIS

Background
The objective of this study was to compare the efficacy, safety, and outcomes of the endoscopic supraorbital approach and frontotemporal approach for the treatment of traumatic frontal hematoma, with the aim of demonstrating the feasibility of the endoscopic supraorbital approach.


Methods
A total of 24 cases underwent hematoma evacuation, including 10 cases using the endoscopic supraorbital approach and 14 cases using the frontotemporal approach. Baseline demographic data, hematoma clearance rate, blood loss, postoperative complications, and 6-month outcomes were retrospectively analyzed.


Results
Both approaches effectively evacuated the hematoma, with hematoma clearance rates of 90.97 ± 10.23% in the endoscopic supraorbital group and 85.29 ± 16.15% in the frontotemporal approach group (p > 0.05). The supraorbital approach group demonstrated significantly shorter operation times compared to the frontotemporal approach group (116.50 ± 28.19 min vs. 193.29 ± 72.55 min, p < 0.05), as well as significantly less blood loss (55.00 ± 33.08 mL vs. 685.71 ± 840.20 mL, p < 0.05). There was no significant difference in the rate of postoperative complications between the two groups, and the majority of patients achieved favorable outcomes with a Glasgow Outcome Scale score of 4 or 5 in both groups.


Conclusion
Compared to the frontotemporal approach, the endoscopic supraorbital approach offers advantages such as shorter operation times, reduced blood loss, similar treatment effects, and comparable complication rates. Therefore, the endoscopic supraorbital approach may serve as a viable alternative for the treatment of traumatic frontal hematoma.

Surgical treatment of traumatic frontal hematoma: comparison of the endoscopic supraorbital approach with frontotemporal approach.

Effect of hypophosphatemia on prognosis after spontaneous intracerebral hemorrhage: a retrospective study

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Mo1343 SMALL-CALIBER EUS-GUIDED CORE BIOPSY NEEDLES ARE A SAFE AND EFFECTIVE MEANS TO DIAGNOSE AUTOIMMUNE PANCREATITIS

Surgical treatment of traumatic frontal hematoma: comparison of the endoscopic supraorbital approach with frontotemporal approach.

Effect of hypophosphatemia on prognosis after spontaneous intracerebral hemorrhage: a retrospective study