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Endoscopy 2017; 49(10): 989-1006
DOI: 10.1055/s-0043-119219
Guideline
© Georg Thieme Verlag KG Stuttgart · New York

Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline – March 2017

Marcin Polkowski
1   Department of Gastroenterology, Hepatology, and Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland
2   Department of Gastroenterological Oncology, The M. Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland
,
Christian Jenssen
3   Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Academic Teaching Hospital of the Medical University of Brandenburg, Germany
,
Philip Kaye
4   Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK
,
Silvia Carrara
5   Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Italy
,
Pierre Deprez
6   Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
,
Angels Gines
7   Endoscopy Unit, Department of Gastroenterology, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Barcelona, Spain
,
Gloria Fernández-Esparrach
7   Endoscopy Unit, Department of Gastroenterology, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Barcelona, Spain
,
Pierre Eisendrath
8   Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Université Libre de Bruxelles, Hôpital Erasme & Hôpital Saint-Pierre, Brussels, Belgium
,
Guruprasad P. Aithal
4   Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK
,
Paolo Arcidiacono
9   Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele University, Milan, Italy
,
Marc Barthet
10   Service de Gastroentérologie, Hôpital NORD AP-HM, Aix-Marseille-Université, Marseille, France
,
Pedro Bastos
11   Gastroenterology Department Instituto Português de Oncologia do Porto, Porto, Portugal
,
Adele Fornelli
12   Anatomic Pathology Unit, AUSL of Bologna, Maggiore Hospital, Bologna, Italy
,
Bertrand Napoleon
13   Department of Gastroenterology, Ramsay Générale de Santé, Private Hospital Jean Mermoz, Lyon, France
,
Julio Iglesias-Garcia
14   Gastroenterology Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
,
Andrada Seicean
15   Regional Institute of Gastroenterology and Hepatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
,
Alberto Larghi
16   Digestive Endoscopy Unit, Catholic University, Rome, Italy
,
Cesare Hassan
16   Digestive Endoscopy Unit, Catholic University, Rome, Italy
,
Jeanin E. van Hooft
17   Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
,
Jean-Marc Dumonceau
18   Gedyt Endoscopy Center, Buenos Aires, Argentina
› Author Affiliations
Further Information

Publication History

Publication Date:
12 September 2017 (online)

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RECOMMENDATIONS

For routine EUS-guided sampling of solid masses and lymph nodes (LNs) ESGE recommends 25G or 22G needles (high quality evidence, strong recommendation); fine needle aspiration (FNA) and fine needle biopsy (FNB) needles are equally recommended (high quality evidence, strong recommendation).

When the primary aim of sampling is to obtain a core tissue specimen, ESGE suggests using 19G FNA or FNB needles or 22G FNB needles (low quality evidence, weak recommendation).

ESGE recommends using 10-mL syringe suction for EUS-guided sampling of solid masses and LNs with 25G or 22G FNA needles (high quality evidence, strong recommendation) and other types of needles (low quality evidence, weak recommendation).

ESGE suggests neutralizing residual negative pressure in the needle before withdrawing the needle from the target lesion (moderate quality evidence, weak recommendation).

ESGE does not recommend for or against using the needle stylet for EUS-guided sampling of solid masses and LNs with FNA needles (high quality evidence, strong recommendation) and suggests using the needle stylet for EUS-guided sampling with FNB needles (low quality evidence, weak recommendation).

ESGE suggests fanning the needle throughout the lesion when sampling solid masses and LNs (moderate quality evidence, weak recommendation).

ESGE equally recommends EUS-guided sampling with or without on-site cytologic evaluation (moderate quality evidence, strong recommendation). When on-site cytologic evaluation is unavailable, ESGE suggests performance of three to four needle passes with an FNA needle or two to three passes with an FNB needle (low quality evidence, weak recommendation).

For diagnostic sampling of pancreatic cystic lesions without a solid component, ESGE suggests emptying the cyst with a single pass of a 22G or 19G needle (low quality evidence, weak recommendation). For pancreatic cystic lesions with a solid component, ESGE suggests sampling of the solid component using the same technique as in the case of other solid lesions (low quality evidence, weak recommendation).

ESGE does not recommend antibiotic prophylaxis for EUS-guided sampling of solid masses or LNs (low quality evidence, strong recommendation), and suggests antibiotic prophylaxis with fluoroquinolones or beta-lactam antibiotics for EUS-guided sampling of cystic lesions (low quality evidence, weak recommendation).

ESGE suggests that evaluation of tissue obtained by EUS-guided sampling should include histologic preparations (e. g., cell blocks and/or formalin-fixed and paraffin-embedded tissue fragments) and should not be limited to smear cytology (low quality evidence, weak recommendation).

Appendix e1, e2 and Supplementary material Table s1 – s14

 

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