All procedures were performed by or under the supervision of one of six experienced attending endosonographers. EUS examinations were usually initiated with an Olympus GF-UM20, GFUM-130 or GF-UM160 radial echoendoscope (Olympus America, Inc., Center Valley,

PA, USA). Curvilinear array endosonography was performed using the Pentax 32-UA, Pentax 36-UX (Pentax Medical Co, Montvale, NJ, USA), Olympus GF-UC30P, or Olympus GF-UC140P-AL5 (Olympus America, Inc., Center Valley, PA, USA) echoendoscope. EUS-FNA was generally performed only if the cyst #see more keyword# size was ≥10 mm and if the endosonographer believed that information gained from cyst fluid analysis would impact patient management. FNA was obtained using a 22-gauge EUSN-1, EUSN-2, EUSN-3, or Echotip Ultra needle (Cook Medical Inc., Winston-Salem, NC, USA) or EZ-Shot needle (Olympus America, Inc., Center Valley, PA, USA). Doppler examination was used to ensure the absence of intervening vascular structures Inhibitors,research,lifescience,medical along the anticipated needle path. Depending on the amount of blood anticipated during tissue sampling, full or partial suction was applied. In general, a single EUS-FNA pass was

performed from the cyst but was repeated if the endosonographer felt that further sampling would increase the yield. Samples aspirated were expressed Inhibitors,research,lifescience,medical onto a glass slide and two smear preparations were made. One slide was air-dried and stained with a modified Inhibitors,research,lifescience,medical Giemsa stain for rapid on-site interpretation, while the other slide was alcohol-fixed and stained by the Papanicolaou method. A cytopathologist was available on-site for preliminary diagnostic interpretations and assessment of specimen adequacy on all procedures. If at least

1 ml of fluid was obtained from the aspirate, analysis for carcinoembryonic antigen (CEA) and amylase was requested. Definitive cytopathologic diagnoses were given only after complete staining and subsequent final interpretation was provided. One dose of intravenous antibiotics (i.e. ampicillin/sulbactam or a fluoroquinolone) was given immediately following the procedure followed by 3-5 days of oral Inhibitors,research,lifescience,medical antibiotics (i.e. amoxicillin/clavulanate or a fluoroquinolone) if EUS-FNA was performed. Per however department policy, all patients were telephoned within 48 hours after the procedure to assess for any short-term complications. Surgery and surgical pathology All surgical consultations and operations were performed by 1 of 5 experienced pancreatobiliary surgeons. Decisions for surgery were based on a preoperative evaluation of the patient’s fitness for operation coupled with the results of all preoperative imaging studies. All patients had complete abdominal exploration by laparoscopy or laparotomy to rule out metastatic or locally advanced disease. A standard pancreaticoduodenectomy or pylorus-preserving variant was done for lesions located in the head or uncinate process.