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Open Access Research article

A Multidisciplinary survey on controversies in the use of EUS-guided FNA: assessing perspectives of surgeons, oncologists and gastroenterologists

Jesse Lachter12*, Yoav Rosenthal2 and Yoram Kluger23

Author Affiliations

1 Department of Gastroenterology, Rambam Health Care Campus, Bat Galim, Haifa, Israel

2 The Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Efron St, Bat Galim, Haifa, Israel

3 Department of Surgery, Rambam Health Care Campus, Bat Galim, Haifa, Israel

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BMC Gastroenterology 2011, 11:117  doi:10.1186/1471-230X-11-117

Published: 2 November 2011

Abstract

Background

EUS-guided FNA can help diagnose and differentiate between various pancreatic and other lesions.

The aim of this study was to compare approaches among involved/relevant physicians to the controversies surrounding the use of FNA in EUS.

Methods

A five-case survey was developed, piloted, and validated. It was collected from a total of 101 physicians, who were all either gastroenterologists (GIs), surgeons or oncologists. The survey compared the management strategies chosen by members of these relevant disciplines regarding EUS-guided FNA.

Results

For CT operable T2NOM0 pancreatic tumors the research demonstrated variance as to whether to undertake EUS-guided FNA, at p < 0.05. For inoperable pancreatic tumors 66.7% of oncologists, 62.2% of surgeons and 79.1% of GIs opted for FNA (p < 0.05). For cystic pancreatic lesions, oncologists were more likely to send patients to surgery without FNA. For stable simple pancreatic cysts (23 mm), most physicians (66.67%) did not recommend FNA. For a submucosal gastric 19 mm lesion, 63.2% of surgeons recommended FNA, vs. 90.0% of oncologists (p < 0.05).

Conclusions

Controversies as to ideal application of EUS-FNA persist. Optimal guidelines should reflect the needs and concerns of the multidisciplinary team who treat patients who need EUS-FNA. Multi-specialty meetings assembled to manage patients with these disorders may be enlightening and may help develop consensus.