T1192 A Randomized Trial of Metabolite-Adjusted Versus Weight-Based Dosing of Azathioprine (AZA) in Crohn's Disease (CD) [Clinicaltrials. Gov Identifier Nct00113503

Abstract

AIM Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an established technique used to sample a variety of abnormalities. A drawback of EUS-FNA is the lack of histologic information necessary to characterize tissue architecture. EUS-guided Trucut biopsy (EUS-TCB) is designed to provide a tissue core with intact architecture when compared to EUS-FNA. Numerous studies have attempted to demonstrate the superiority of EUS-TCB over EUS-FNA but have been unable to individually demonstrate statistical significance. Our aim was to compare the diagnostic accuracy of EUS-FNA with that of EUS-TCB using a systematic review of existing studies. METHODWe performed a literature search of studies comparing the accuracy of EUS-FNA with EUS-TCB. Data comparing these two modalities, including diagnostic accuracy, the number of passes and their complication rates were extracted, pooled and analyzed. RESULTS Eight studies (n = 424, 5 prospective and 3 retrospective) were identified. The overall diagnostic accuracy for EUS-FNA was 80% (340/ 425) and for EUS-TCB was 80% (290/362). The most common reasons for EUS-TCB failure was an inadequate amount of tissue biopsied or failure to deploy the TCB needle, which typically occurred during a trans-duodenal approach. Six studies assessed the overall combined diagnostic accuracy of both modalities to be 97% (308/318). The average number of needle passes for EUS-FNA was 3.6 (range 1.3-6.5) and EUS-TCB was 2.4 (range 1.2-4.1). The complication rates for EUS-FNA and EUS-TCB were 1.4% and 2.1% respectively (NS). CONCLUSION This systematic analysis demonstrates no significant difference in the diagnostic accuracy of EUS-FNA compared to EUS-TCB. However, there is a significant increase in diagnostic accuracy when these two modalities are combined. As EUS-TCB has certain technical limitations, its clinical applicability may need to be individualized for each patient.