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Magahis PT, Westerveld D, Simons M, Carr-Locke DL, Sampath K, Sharaiha RZ, Mahadev S. Outcomes of Endoscopic Ultrasound-guided Fine Needle Biopsy Using a Novel Hydrostatic Stylet Tissue Acquisition Technique. J Clin Gastroenterol 2024; 58:407-414. [PMID: 37983811 DOI: 10.1097/mcg.0000000000001934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/28/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) is frequently used to obtain core samples of solid lesions. Here, we describe and evaluate a novel hydrostatic stylet (HS) technique designed to optimize core sample acquisition, reporting diagnostic yield, efficacy, and safety relative to the conventional stylet slow-pull (SP) technique. METHODS A novel HS technique was developed and validated retrospectively. Consecutive patients who underwent EUS-FNB with core biopsy of solid lesions through either the HS or SP technique between January 2020 and April 2022 were included. Exclusion criteria included cystic lesions, nonlesional liver biopsies, and specimens sent for cytologic analysis only. Patient and lesion characteristics, number of passes, sample adequacy, and adverse events were compared between the two techniques. RESULTS A total of 272 patients were included with 138 in the HS group and 134 in the SP group. Lesion size and anatomic distribution were similar in both groups. Compared with the SP approach, the HS technique demonstrated significantly higher sample adequacy (97.8% vs 83.6%, P < 0.001), higher sensitivity (97.1% vs 89.7%, P = 0.03), and lower mean number of passes (1.2 vs 3.3, P < 0.001). Rates and severity of adverse events in the HS group were comparable to the SP group and existing literature. Similar associations were observed in pancreatic and nonpancreatic lesion subanalyses. CONCLUSIONS The novel HS technique demonstrated excellent biopsy sample adequacy and diagnostic yield while requiring fewer passes to obtain diagnostic specimens compared with a conventional EUS-FNB approach. Further prospective evaluation is needed to confirm these pilot findings and optimize EUS-FNB acquisition techniques.
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Affiliation(s)
| | - Donevan Westerveld
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - Malorie Simons
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - David L Carr-Locke
- MD Program, Weill Cornell Medical College
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - Kartik Sampath
- MD Program, Weill Cornell Medical College
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - Reem Z Sharaiha
- MD Program, Weill Cornell Medical College
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - SriHari Mahadev
- MD Program, Weill Cornell Medical College
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
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Xu S, Wang J, Guo J, Xie F, Qiao W, Meng Y, Peng P, Hu H, Huang Y, Liu S, Qin M, Yao J, Li Y. Dry suction versus wet suction technique of endoscopic ultrasound-guided fine-needle biopsy for diagnosis of solid pancreatic lesions: study protocol of a multicenter randomized controlled non-inferiority trial. Trials 2023; 24:805. [PMID: 38093381 PMCID: PMC10717723 DOI: 10.1186/s13063-023-07842-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Studies have shown that the wet suction technique in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) generates better histological diagnostic accuracy and specimen quality than the dry suction technique. However, conclusions of wet suction on the diagnostic accuracy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) are still controversial. Besides, the optimal number of passes for EUS-FNB has not been determined. We aimed to design a large multicenter randomized trial to compare the diagnostic accuracy of dry suction versus wet suction technique in solid pancreatic lesions (SPLs) using 22G Franseen needles and determine the optimal number of passes required for EUS-FNB. METHODS This is a multi-center open-label, randomized controlled non-inferiority trial with two parallel groups. Two hundred patients with SPLs will undergo EUS-FNB using 22G Franseen needles in 4 tertiary hospitals in China and will be randomly assigned to the dry suction group and wet suction group in a ratio of 1:1. The primary endpoint is diagnostic accuracy. Secondary endpoints include the optimal number of needle passes, sensitivity, specificity, specimen quality, cytological diagnoses, time of the procedure, and incidence of complications. DISCUSSION This study has been designed to determine (i) whether EUS-FNB using 22G Franseen needle with dry suction is non-inferior to wet suction in terms of diagnostic accuracy and (ii) the optimal number of passes during EUS-FNB of SPLs using 22G Franseen needle. TRIAL REGISTRATION ClinicalTrials.gov NCT05549856. Registered on September 22, 2022.
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Affiliation(s)
- Shenglin Xu
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Junfen Wang
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianian Guo
- Department of Gastroenterology, Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Fang Xie
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Weiguang Qiao
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yiteng Meng
- Department of Gastroenterology, Shenzhen People's Hospital, Second Clinical Medical Sciences of Jinan University, Shenzhen, China
| | - Peng Peng
- Department of Gastroenterology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Haiyan Hu
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ying Huang
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Side Liu
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mengbin Qin
- Department of Gastroenterology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jun Yao
- Department of Gastroenterology, Shenzhen People's Hospital, Second Clinical Medical Sciences of Jinan University, Shenzhen, China
| | - Yue Li
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Giri S, Afzalpurkar S, Angadi S, Marikanty A, Sundaram S. Comparison of suction techniques for EUS-guided tissue acquisition: Systematic review and network meta-analysis of randomized controlled trials. Endosc Int Open 2023; 11:E703-E711. [PMID: 37564335 PMCID: PMC10411163 DOI: 10.1055/a-2085-3674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/12/2023] [Indexed: 08/12/2023] Open
Abstract
Background and study aims Despite the widespread use of endoscopic ultrasound (EUS)-guided tissue acquisition, the choice of optimal suction technique remains a subject of debate. Multiple studies have shown conflicting results with respect to the four suction techniques: Dry suction (DS), no suction (NS), stylet slow-pull (SSP) and wet suction (WS). Thus, the present network meta-analysis (NMA) was conducted to compare the diagnostic yields of above suction techniques during EUS-guided tissue acquisition. Methods A comprehensive literature search from 2010 to March 2022 was done for randomized trials comparing the aspirated sample and diagnostic outcome with various suction techniques. Both pairwise and network meta-analyses were performed to analyze the outcomes: sample adequacy, moderate to high cellularity, gross bloodiness and diagnostic accuracy. Results A total of 16 studies (n=2048 patients) were included in the final NMA. WS was associated with a lower odd of gross bloodiness compared to DS (odds ratio 0.50, 95% confidence interval 0.24-0.97). There was no significant difference between the various suction methods with respect to sample adequacy, moderate to high cellularity and diagnostic accuracy. On meta-regression, to adjust for the effect of needle type, WS was comparable to DS in terms of bloodiness when adjusted for fine-needle aspiration needle. Surface under the cumulative ranking analysis ranked WS as the best modality for all the outcomes. Conclusions The present NMA did not show superiority of any specific suction technique for EUS-guided tissue sampling with regard to sample quality or diagnostic accuracy, with low confidence in estimates.
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Affiliation(s)
- Suprabhat Giri
- Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | | | - Sumaswi Angadi
- Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Adarsh Marikanty
- General Medicine, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India
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Poiraud M, Gkolfakis P, Arvanitakis M. Recent Developments in the Field of Endoscopic Ultrasound for Diagnosis, Staging, and Treatment of Pancreatic Lesions. Cancers (Basel) 2023; 15:cancers15092547. [PMID: 37174012 PMCID: PMC10177103 DOI: 10.3390/cancers15092547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Endoscopic ultrasound (EUS) plays a crucial role in the diagnosis of both solid and cystic pancreatic lesions and in the staging of patients with pancreatic cancer through its use for tissue and fluid sampling. Additionally, in cases of precancerous lesions, EUS-guided therapy can also be provided. This review aims to describe the most recent developments regarding the role of EUS in the diagnosis and staging of pancreatic lesions. Moreover, complementary EUS imaging modalities, the role of artificial intelligence, new devices, and modalities for tissue acquisition, and techniques for EUS-guided treatment are discussed.
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Affiliation(s)
- Marie Poiraud
- Department of Gastroenterology, CUB Erasme Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, CUB Erasme Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Marianna Arvanitakis
- Department of Gastroenterology, CUB Erasme Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium
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Chen D, Ren Y, Chen S, Jin Y, Xie H, Yu L, Peng K, Xia Y, Pan D, Lu J, Lu L, Wan X, Hu D, Li B. The Wet Suction Technique Enhances the Diagnostic Efficacy and Aspirate Quality of EUS-FNA for Solid Lesions: A Multicenter Retrospective Study in China. J Clin Gastroenterol 2023; 57:417-422. [PMID: 35389928 DOI: 10.1097/mcg.0000000000001700] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 03/08/2022] [Indexed: 12/10/2022]
Abstract
GOALS To comprehensively compare the wet suction technique with the conventional dry suction technique for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in solid lesions. BACKGROUND Optimal suction techniques for EUS-FNA remain uncertain when approaching solid lesions. STUDY We performed a retrospective study of EUS-FNA at 3 medical centers in China. A total of 203 patients were enrolled who received 2 passes of EUS-FNA with 22-G needles. If the first pass underwent dry suction, the second pass was wet suction. Otherwise, the order of suction technique is opposite. Diagnostic accuracy, sample quality (including cellularity and blood contamination), and sample quantity (including specimen adequacy, the maximum intact specimen length, and the total specimen length) were compared between wet-suction and dry-suction techniques. RESULTS The patients included 143 pancreatic lesions and 60 nonpancreatic lesions. Compared with the dry suction technique, the wet suction technique yielded a significantly higher diagnostic accuracy (85.22% vs. 72.41%, P =0.002), better specimen adequacy score and cellularity score ( P <0.0001), and lower blood contamination score ( P <0.0001). In the subgroup analysis, wet suction provided significantly higher diagnostic accuracy in pancreatic cancer without chronic pancreatitis ( P <0.05), and better cellularity score and specimen adequacy score, lower blood contamination score, and longer maximum intact specimen length and total specimen length in various lesions than that in dry suction. CONCLUSIONS The wet suction technique resulted in significantly higher diagnostic accuracy in pancreatic cancer without chronic pancreatitis, and better cellularity and histologic specimen in most of solid lesions.
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Affiliation(s)
| | | | - Sumin Chen
- Department of Gastroenterology, Tongren Hospital
| | - Yubiao Jin
- Department of Pathology, Shanghai General Hospital
| | | | | | | | | | - Dan Pan
- Department of Gastroenterology, The Fifth People's Hospital of Zunyi, Guizhou
| | | | | | - Xinjian Wan
- Department of Gastroenterology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Duanmin Hu
- Department of Gastroenterology, The Second Hospital of Soochow University, Soochow, Jiangsu, China
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Tong T, Zhang C, Li J, Deng M, Wang X. Preclinical models derived from endoscopic ultrasound-guided tissue acquisition for individualized treatment of pancreatic ductal adenocarcinoma. Front Med (Lausanne) 2023; 9:934974. [PMID: 36687406 PMCID: PMC9849774 DOI: 10.3389/fmed.2022.934974] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with poor outcomes. Although the management strategies have evolved in recent years, the PDAC 5-year survival rate remains at only 9%; it may become the second leading cause of cancer death in the USA by 2030. Only 15-20% of PDAC patients are eligible to undergo surgery; diagnostic biopsies and individualized treatment present a more significant challenge for the remaining group. Endoscopic ultrasound-guided tissue acquisition (EUS-TA) has been widely used in the diagnosis of pancreatic masses. With the advancement of this sampling technique, adequate specimens can be obtained from all patients with PDAC in both early and late clinical stages. Recent data suggest that the specimens obtained from EUS-TA might be used to establish viable preclinical models, which conserve the genetic mutation and preserve the heterogeneity of the original tumors. Additionally, any drug sensitivity evident in the EUS-TA-derived preclinical models might predict the clinical response, thus guiding the prospective therapeutic selection. As we move toward the era of precision medicine, this review provides an update on the role of EUS-TA as a method for obtaining genetic material used in preclinical models that can assess and stratify individuals according to their individual cancer biology.
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Affiliation(s)
- Ting Tong
- Endoscopic Center, The First Affiliated Hospital of Xiamen University, Xiamen, China,Endoscopic Center, Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Non-Resolving Inflammation and Cancer, Central South University, Changsha, China
| | - Chao Zhang
- Endoscopic Center, Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Non-Resolving Inflammation and Cancer, Central South University, Changsha, China
| | - Jingbo Li
- Endoscopic Center, Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Non-Resolving Inflammation and Cancer, Central South University, Changsha, China
| | - Minzi Deng
- Endoscopic Center, Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Non-Resolving Inflammation and Cancer, Central South University, Changsha, China,*Correspondence: Minzi Deng,
| | - Xiaoyan Wang
- Endoscopic Center, Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Non-Resolving Inflammation and Cancer, Central South University, Changsha, China,Xiaoyan Wang,
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Zakaria A, Diab A, Dowd M, Taunk P, Abbas A. EUS-guided liver biopsy using a modified wet heparin suction technique. VideoGIE 2022; 7:348-349. [PMID: 36238803 PMCID: PMC9551452 DOI: 10.1016/j.vgie.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ali Zakaria
- Division of Advanced Endoscopy, Moffitt Cancer Center, Tampa, Florida
- Division of Digestive Disease and Nutrition, Tampa General Hospital, University of South Florida, Tampa, Florida
| | - Abdulrahman Diab
- Division of Digestive Disease and Nutrition, Tampa General Hospital, University of South Florida, Tampa, Florida
| | - Michael Dowd
- Division of Digestive Disease and Nutrition, Tampa General Hospital, University of South Florida, Tampa, Florida
| | - Pushpak Taunk
- Division of Digestive Disease and Nutrition, Tampa General Hospital, University of South Florida, Tampa, Florida
| | - Ali Abbas
- Division of Digestive Disease and Nutrition, Tampa General Hospital, University of South Florida, Tampa, Florida
- Division of Digestive Disease and Nutrition, Tampa General Hospital, University of South Florida, Tampa, Florida
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Sun L, Li S, Wang K. Rapid Onsite Evaluation for Endoscopic Ultrasound-Guided Fine-Needle Biopsy: Are There Any Other Applicable Situations? Gastroenterology 2022; 162:655. [PMID: 34174245 DOI: 10.1053/j.gastro.2021.06.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Liqi Sun
- Department of Gastroenterology, Changhai Hospital, The Second/Navy Military Medical University, Shanghai, China
| | - Shiyu Li
- Department of Gastroenterology, Changhai Hospital, The Second/Navy Military Medical University, Shanghai, China
| | - Kaixuan Wang
- Department of Gastroenterology, Changhai Hospital, The Second/Navy Military Medical University, Shanghai, China
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Vozzo C, Saleh MA, Drake R, Chahal P. Endoscopic ultrasound-guided liver biopsy: needle types and suction methods. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2021; 6:485-486. [PMID: 34765836 PMCID: PMC8573426 DOI: 10.1016/j.vgie.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Video 1Tools and techniques: understanding EUS-guided liver biopsy needle types and tissue acquisition techniques.
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Affiliation(s)
- Catherine Vozzo
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Mohannad Abou Saleh
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Richard Drake
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Cleveland, Ohio
| | - Prabhleen Chahal
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio
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