Impact of rapid on‐site evaluation on the adequacy of endoscopic‐ultrasound guided fine‐needle aspiration of solid pancreatic lesions: A systematic review and meta‐analysis

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Rapid on‐site evaluation (<jats:styled-content style="fixed-case">ROSE</jats:styled-content>) has the potential to improve adequacy rates for endoscopic ultrasound‐guided fine needle aspiration (<jats:styled-content style="fixed-case">EUS‐FNA</jats:styled-content>) of solid pancreatic lesions, but its impact is context‐dependent. No studies exist that summarize the relationship between <jats:styled-content style="fixed-case">ROSE</jats:styled-content>, number of needle passes, and resulting adequacy rates.</jats:p></jats:sec><jats:sec><jats:title>Aims</jats:title><jats:p>To analyze data from previous studies to establish if <jats:styled-content style="fixed-case">ROSE</jats:styled-content> is associated with improved adequacy rates; to evaluate the relationship between <jats:styled-content style="fixed-case">ROSE</jats:styled-content>, number of needle passes, and the resulting adequacy rates of <jats:styled-content style="fixed-case">EUS‐FNA</jats:styled-content> for solid pancreatic lesions.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Systematic review and meta‐analysis of studies reporting the adequacy rates for <jats:styled-content style="fixed-case">EUS‐FNA</jats:styled-content> of solid pancreatic lesions.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The search produced 3822 original studies, of which 70 studies met our inclusion criteria. The overall average adequacy rate was 96.2% (95% confidence interval: 95.5, 96.9). <jats:styled-content style="fixed-case">ROSE</jats:styled-content> was associated with a statistically significant improvement of up to 3.5% in adequacy rates. There was heterogeneity in adequacy rates across all subgroups. No association between the assessor type and adequacy rates was found. Studies with <jats:styled-content style="fixed-case">ROSE</jats:styled-content> have high per‐case adequacy and a relatively high number of needle passes in contrast to non‐<jats:styled-content style="fixed-case">ROSE</jats:styled-content> studies. <jats:styled-content style="fixed-case">ROSE</jats:styled-content> is an effect modifier of the relationship between number of needle passes and adequacy.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p><jats:styled-content style="fixed-case">ROSE</jats:styled-content> is associated with up to 3.5% improvement in adequacy rates for <jats:styled-content style="fixed-case">EUS‐FNA</jats:styled-content> of solid pancreatic lesions. <jats:styled-content style="fixed-case">ROSE</jats:styled-content> assessor type has no impact on adequacy rates. <jats:styled-content style="fixed-case">ROSE</jats:styled-content> is an effect modifier on the relationship between needle passes and per‐case adequacy for <jats:styled-content style="fixed-case">EUS‐FNA</jats:styled-content> of solid pancreatic lesions.</jats:p></jats:sec>