Comparison of postprocedural adverse events between same-day and separate-day combined EUS-guided fine-needle aspiration/biopsy and endoscopic retrograde cholangiopancreatography in patients with pancreatic mass and biliary obstruction: A retrospective cohort study

Background and Objective: The optimal timing between endoscopic retrograde cholangiopancreatography (ERCP) and EUS-guided fine-needle aspiration/biopsy (EUS-FNA/B) remains undefined. This study compared The optimal timing between endoscopic retrograde cholangiopancreatography (ERCP) and EUS-guided fine-needle aspiration/biopsy (EUS-FNA/B) remains undefined. This study compared the safety and efficacy of same-day versus separate-day procedures.the safety and efficacy of same-day versus separate-day procedures. Methods: We conducted a retrospective analysis of 362 patients with pancreatic mass and biliary obstruction who underwent EUS-FNA/B and ERCP during one hospitalization period at Changhai Hospital between January 2017 and February 2024. Outcomes included adverse events, technical success of biliary stenting, and diagnostic yield of EUS-FNA/B. Logistic regression identified risk factors for adverse events. Results: Patients were stratified into same-day (group A, n = 60) and separate-day (group B, n = 302) groups. No perforations occurred in either group. Rates of pancreatitis (10.0% vs. 9.3%), infection (10.0% vs. 8.3%), and bleeding (1.7% vs. 3.7%) were comparable (all P > 0.05). Technical success of biliary stenting (96.7% vs. 96.7%) and diagnostic yield of EUS-FNA/B (80.0% vs. 84.8%) showed no intergroup differences. Notably, same-day procedures significantly shortened median hospital stay (6 [4–8.75] days vs. 7 [6–10] days, P = 0.002). Multivariable analysis identified advancing age (odds ratio [OR]: 0.957; 95% confidence interval [CI], 0.924–0.991; P = 0.014) and larger mass short-axis diameter (OR: 0.918; 95% CI, 0.868–0.971; P = 0.003) as independent protective factors against pancreatitis, while overweight status (body mass index > 23.9 kg/m 2 ) increased pancreatitis risk (OR: 3.491; 95% CI, 1.574–7.744; P = 0.002). Precut sphincterotomy was independently associated with bleeding risk (OR: 1.607; 95% CI, 1.230–20.242; P = 0.024). Crucially, the same-day procedure was not linked to increased adverse events. Conclusion: Same-day ERCP and EUS-FNA/B is safe and feasible, does not increase adverse events, and reduces hospital stay.