S986 Efficacy and Safety of Endoscopic Ultrasound-Guided Fine Needle Aspiration of Splenic Lesions and/or Parenchyma: A Systematic Review and Meta-Analysis

Abstract

Introduction: Lesions of the spleen can be caused by a wide variety of disease process, like lymphomas, leukemias, tuberculosis, malaria etc. In majority of such circumstances a fine needle aspiration (FNA) or biopsy of the spleen is paramount in making an accurate diagnosis. FNA of the spleen is traditionally done under ultrasound or computed tomography guidance. However, recently, Endoscopic ultrasound (EUS) guided FNA of spleen has been evaluated and reported to this end. EUS has the theoretical advantage of high-resolution imaging of small lesions with no hinderance of bowel gas. Data is limited on the clinical outcomes of EUS-guided FNA of lesions of the spleen. We conducted this meta-analysis to study the usefulness and safety of EUS-guided FNA of the spleen. Methods: Multiple databases including Medline, Embase, Scopus were searched and appropriate studies were collected that reported on the clinical outcomes of EUS guided spleen biopsy. The outcomes assessed were the pooled technical success, successful diagnosis made, and adverse events. Data pertaining to the type of needle used and number of passes were also collected. Meta-analysis was conducted using standard methodology using the random-effects model, and heterogeneity was assessed using the I2% and 95% prediction interval. Results: 6 studies (62 patients) were included in the final analysis. 56.5% were male. The indication for the procedure in majority of cases was to rule out lymphoma and/ or leukemia. A small percentage of patients were diagnosed with tuberculosis and sarcoidosis. A 22gauge needle was used in 50 patients (81%), 19gauge in 7 patients (11%), and a 25gauge needle was used in 5 patients (8%). An average of 2 to 5 needle passes were performed for tissue aspiration. The pooled technical success was 95.3% (95% CI[86.3-98.5]), successful diagnosis made was 86.2%[73.3-93.4]. A case of mild abdomen pain was reported in one patient, and the calculated pooled adverse events was 6.9%[2.4-18.2], which did not warrant hospital admission and/ or observation. Conclusion: EUS-guided FNA of spleen demonstrates high pooled technical success rate with excellent pooled rate of successful diagnoses made, with minimal heterogeneity. Moreover, EUS-guided spleen biopsy seems to be a highly safe procedure. Majority of the results can be achieved using a 25gauge FNA needle with 2 to 5 passes. Based on this meta-analysis EUS-guided FNA of spleen should be highly considered in the right clinical scenario and performed by experienced endoscopists.Table 1.: Table-1: Summary of pooled results