['Rapid on-site evaluation (ROSE) has the potential to improve adequacy rates and affect other outcomes; however, there have been few comparative studies to assess the impact of ROSE in the setting of ultrasound-guided endoscopic fine-needle aspiration cytology for pancreatic lesions.', 'To determine whether ROSE improves adequacy rates of endoscopic fine-needle aspiration cytology for pancreatic lesions.', 'Systematic review and meta-analysis of studies reporting a head-to-head comparison of adequacy or diagnostic accuracy (with ROSE vs. without ROSE) at a single site.', 'ROSE was associated with a statistically significant (p\xa0<\xa00.001) improvement in the adequacy rate (average 10\xa0%, 95\xa0% CI: 5-24\xa0%). The impact of ROSE depends on the per-pass adequacy rate without ROSE. ROSE had no impact on diagnostic yield (p\xa0<\xa00.76).'] Does rapid on-site evaluation increase endoscopic ultrasound-guided fine-needle aspiration adequacy for pancreatic lesions?