Abstract
BACKGROUND: Endoscopic ultrasound (EUS) has emerged as a key diagnostic and therapeutic modality due to its minimally invasive nature and high success rates. It is widely used for diagnosing and staging gastrointestinal (GI), pancreatobiliary, and lung malignancies. EUS-guided fine needle biopsy (EUS-FNB) provides preserved tissue architecture, improving histological diagnosis for such conditions. The elderly are at significantly higher risk of GI lesions, being ten times more prone to malignancy and experiencing higher mortality, thereby requiring safer and less invasive diagnostic approaches. Despite its increasing use, evidence on EUS-FNB safety and diagnostic yield in geriatric population, particularly from resource-limited settings, remains limited. AIM: To assess the indications, diagnostic efficacy, and safety profile of EUS-FNB in the geriatric population. METHODS: This single-centre retrospective study included patients aged 65 years or above who underwent EUS-guided biopsy between June 2020 and June 2022 at Aga Khan University Hospital, a tertiary care centre in Karachi, Pakistan. Patient demographics, procedural details including lesion site, number of needle passes, needle type, and tissue acquisition technique, along with histopathological diagnosis, were extracted from medical records. Data were analysed using SPSS, with categorical variables reported as frequencies and percentages, and continuous variables as mean ± SD. RESULTS: A total of 67 elderly patients were included, with a mean age of 72.7 ± 6.33 years; most were male (72%). The median duration of the EUS procedure was 19 (23) minutes. Most patients underwent biopsy for pancreatic lesions (40.3%), followed by mediastinal (16.4%) and gallbladder/common bile duct lesions (13.4%). In 31.4% cases, the specimen was obtained with 2 needle passes, while 41.4% required 1 pass and 22.9% required 3 passes. Multi-targeted biopsies using a single pass were performed in 7.5% cases. A Franseen-design needle was used in all cases, with 22G utilized in 92.5% and 25G in 7.5%. Diagnostic adequacy was 100%, with no procedure-related complications. Histopathology revealed pancreatic cancer (34.3%), benign lesions (28.4%), and metastatic renal carcinoma (6%). CONCLUSION: EUS-FNB is an effective minimally invasive diagnostic tool in elderly, demonstrating high diagnostic adequacy without complications. Future studies are warranted to further validate its safety and effectiveness in this population.