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Comparison of the Outcomes of Endoscopic Ultrasound Based on Community Hospital Versus Tertiary Academic Center Settings

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Abstract

Objective

Endoscopic ultrasound (EUS) is an established tool in the management of gastrointestinal diseases. The majority of EUS procedures are performed in tertiary care hospitals but the technology has also disseminated to community hospitals. The data from community hospitals are limited and there are no published studies comparing EUS-fine needle aspiration (FNA) outcomes in community versus tertiary settings. Our objective is to compare EUS procedures performed in these two separate settings.

Methods

EUS procedures performed for pancreatobiliary indications in an academic tertiary care hospital and a community hospital were retrospectively reviewed and compared. The patient demographics, procedure time, procedure indications, FNA performed, pass counts, needle size, rapid onsite evaluation (ROSE) and final cytological diagnosis were compared between the two centers. Cytological diagnosis was categorized as satisfactory and unsatisfactory samples.

Results

There was no significant difference in patient age, gender, indications, procedure time, FNA performed, needle size, or pass counts between the tertiary hospital (n = 361) and community hospital (n = 119). ROSE was a significant determinant factor for adequacy of sample. There was a positive linear relationship between adequacy of the sample and number of pass counts. After performing a logistic regression and adjusting for target site, the overall odds of having an unsatisfactory specimen were not significantly different at the two centers (OR 0.51, CI 0.23–1.17, p = 0.11). Percentages of unsatisfactory samples were not significantly different at the two centers for solid lesions (7.4 vs. 3.1 %, p = 0.33), cysts (33.3 vs. 23.8 %, p = 0.31,) or lymph nodes (25.0 vs. 0 %, p = 0.063).

Conclusion

Cytological yield of EUS-FNA in a community hospital is similar to that of a tertiary hospital. Community hospitals can provide EUS services with reasonable success.

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Authors and Affiliations

  1. Division of Gastroenterology, West Penn Allegheny Health System, 320 East North Avenue, Pittsburgh, PA, 15212, USA

    Shailendra Singh, Elie Aoun, Yatindra Patel, Neil Carleton, Marcia Mitre, Suzanne Morrissey, Manish Dhawan & Shyam Thakkar

  2. Division of Internal Medicine, Westchester Medical Center, N.Y.M.C., Valhalla, NY, USA

    Treta Purohit

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  1. Shailendra Singh
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  2. Treta Purohit
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  3. Elie Aoun
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  4. Yatindra Patel
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  5. Neil Carleton
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  6. Marcia Mitre
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  7. Suzanne Morrissey
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  8. Manish Dhawan
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  9. Shyam Thakkar
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Correspondence to Shailendra Singh.

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Singh, S., Purohit, T., Aoun, E. et al. Comparison of the Outcomes of Endoscopic Ultrasound Based on Community Hospital Versus Tertiary Academic Center Settings. Dig Dis Sci 59, 1925–1930 (2014). https://doi.org/10.1007/s10620-014-3075-9

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  • DOI: https://doi.org/10.1007/s10620-014-3075-9

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