The role of rapid on-site evaluation in pancreatic lesion: a systematic review and meta-analysis of randomized control trials.

Background: Endoscopic ultrasonography is crucial for diagnosing solid pancreatic lesions. Tissue acquisition using rapid on-site evaluation (ROSE) significantly improves diagnostic efficiency.

Objectives: This study evaluates the efficacy of tissue acquisition from pancreatic tumors with and without ROSE.

Design: Systematic review and meta-analysis.

Data sources and methods: A search was conducted in PubMed and other databases covering the period up to February 2024. Eligible randomized control trials (RCTs) reporting data on comparing the efficacy of ROSE and no ROSE were included in this study. We compare the two groups using odd ratios (OR) and mean difference approach.

Results: This meta-analysis included seven RCTs, including 1723 patients (909 in the ROSE and 814 in the no-ROSE group) with pancreatic masses. The fundamental characteristics of the studies were almost identical in both groups. There was no significant difference (p > 0.05) in the mean procedure time (1.49 min, 95% CI: -2.76, 5.75), needle passes (-0.34 passes, 95% CI: -1.00, 0.32), The OR of sample adequacy 1.34 (95% CI: 0.29, 6.25), diagnostic sensitivity 1.95 (95% CI: -0.79, 4.82), accuracy 1.28 (95% CI 0.54, 3.00), negative predictive value 1.05 (95% CI 0.54, 2.06), and adverse events 0.87 (95% CI 0.16, 4.87) with significant higher heterogeneity. Subgroup analysis also showed no difference between the FNA + ROSE versus FNA and FNB.

Conclusion: The ROSE and non-ROSE approaches showed similar outcomes regarding mean needle passes, sample adequacy, diagnostic accuracy, and adverse event rates.

Trial registration: This systematic review and meta-analysis was registered at PROSPERO (https://www.crd.york.ac.uk/PROSPERO/) with PROSPERO Number CRD42024520977.