Evaluating clinical outcomes and adverse events: risk stratification of endoscopic ultrasound-guided through-the-needle biopsy for pancreatic cyst in a large cohort

Ho Seung Lee; Tae Jun Song; Dongwook Oh; Gunn Hur; Sung Hyun Cho; Dong-Wan Seo

doi:10.1016/j.gie.2026.01.030

Evaluating clinical outcomes and adverse events: risk stratification of endoscopic ultrasound-guided through-the-needle biopsy for pancreatic cyst in a large cohort

Gastrointest Endosc. 2026 Jan 29:S0016-5107(26)00071-4. doi: 10.1016/j.gie.2026.01.030. Online ahead of print.

Authors

Ho Seung Lee¹, Tae Jun Song², Dongwook Oh², Gunn Hur², Sung Hyun Cho², Dong-Wan Seo³

Affiliations

¹ Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea; Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
² Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
³ Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand. Electronic address: dwseoamc@amc.seoul.kr.

PMID: 41620141
DOI: 10.1016/j.gie.2026.01.030

Abstract

Background and aims: Despite concerns regarding its safety and the incidence of adverse events (AEs), EUS-guided through-the-needle biopsy (EUS-TTNB) has emerged as a promising diagnostic tool. This study evaluated the clinical effectiveness of EUS-TTNB, assessed procedural AEs, and categorized risks based on predictive factors using recursive partitioning analysis (RPA).

Methods: This retrospective study included 301 patients who underwent EUS-TTNB at Asan Medical Center, Seoul, South Korea, using permutation-based accuracy and RPA.

Results: EUS-TTNB exhibited high diagnostic adequacy (80.3%, 241/301), showed strong histologic concordance among surgically resected cases (87.5%, 42/48), and led to changes in diagnosis and management in 16.3% of cases (49/301). AEs occurred in 20.9% of cases, with acute pancreatitis being the most common (15%, 45/301). Multivariable analysis identified intraductal papillary mucinous neoplasm (IPMN) (odds ratio [OR], 2.24 [95% CI, 1.26-3.98]; P = .006) and complete cyst aspiration (OR, 0.50 [95% CI, 0.28-0.90]; P = .02) as significant risk factors for AEs. In RPA, a random forest model and permutation-based accuracy were used to create 3 risk categories: low (AE rate: 11.9%, non-IPMN with complete cyst aspiration or ≥ 4 through-the-needle biopsies); high (AE rate: 37.0%, IPMN with age ≥ 70 or without complete cyst aspiration); and moderate (AE rate: 20.6%, not classified as low or high risk).

Conclusions: EUS-TTNB demonstrated notable clinical utility in revising diagnoses and influencing therapeutic decisions but poses a considerable risk of AEs. By applying this risk categorization model with careful consideration and patient selection, its clinical utility may be enhanced.