Wet-suction versus slow-pull technique for endoscopic ultrasound-guided fine-needle biopsy: a multicenter, randomized, crossover trial

Stefano Francesco Crinò; Maria Cristina Conti Bellocchi; Roberto Di Mitri; Frediano Inzani; Mihai Rimbaș; Andrea Lisotti; Guido Manfredi; Anthony Y. B. Teoh; Benedetto Mangiavillano; Oriol Sendino; Laura Bernardoni; Erminia Manfrin; Daniela Scimeca; Elettra Unti; Angela Carlino; Theodor Voiosu; R. Bogdan Mateescu; Pietro Fusaroli; Stefania Lega; Elisabetta Buscarini; Lorena Pergola; Shannon M. Chan; Laura Lamonaca; Àngels Ginès; Gloria Fernández-Esparrach; Antonio Facciorusso; Alberto Larghi

doi:10.1055/a-1915-1812

Endoscopy, Table of Contents

Endoscopy 2023; 55(03): 225-234
DOI: 10.1055/a-1915-1812

Original article

Wet-suction versus slow-pull technique for endoscopic ultrasound-guided fine-needle biopsy: a multicenter, randomized, crossover trial

Stefano Francesco Crinò

¹Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy

,

Maria Cristina Conti Bellocchi

¹Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy

,

Roberto Di Mitri

²Gastroenterology and Endoscopy Unit, Arnas Civico Di Cristina Benfratelli Hospital, Palermo, Italy

,

Frediano Inzani

³Pathology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

,

Mihai Rimbaș

⁴Gastroenterology Department, Clinic of Internal Medicine, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania

,

Andrea Lisotti

⁵Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy

,

Guido Manfredi

⁶Gastroenterology and Digestive Endoscopy Department, ASST Ospedale Maggiore Crema, Crema, Italy

,

Anthony Y. B. Teoh

⁷Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong

,

Benedetto Mangiavillano

⁸Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy

⁹Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

,

Oriol Sendino

¹⁰Endoscopy Unit, Department of Gastroenterology, Hospital Clínic Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain

,

Laura Bernardoni

¹Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy

,

Erminia Manfrin

¹¹Department of Diagnostics and Public Health, G.B. Rossi University Hospital, Verona, Italy

,

Daniela Scimeca

²Gastroenterology and Endoscopy Unit, Arnas Civico Di Cristina Benfratelli Hospital, Palermo, Italy

,

Elettra Unti

¹²Pathology Unit, ARNAS Civico Di Cristina Benfratelli Hospital, Palermo, Italy

,

Angela Carlino

³Pathology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

,

Theodor Voiosu

⁴Gastroenterology Department, Clinic of Internal Medicine, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania

,

R. Bogdan Mateescu

⁴Gastroenterology Department, Clinic of Internal Medicine, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania

,

Pietro Fusaroli

⁵Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy

,

Stefania Lega

¹³Pathology Unit, Hospital of Imola, Imola, Italy

,

Elisabetta Buscarini

⁶Gastroenterology and Digestive Endoscopy Department, ASST Ospedale Maggiore Crema, Crema, Italy

,

Lorena Pergola

¹⁴Pathology Department, ASST Ospedale Maggiore Crema, Crema, Italy

,

Shannon M. Chan

⁷Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong

,

Laura Lamonaca

⁸Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy

,

Àngels Ginès

¹⁰Endoscopy Unit, Department of Gastroenterology, Hospital Clínic Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain

,

Gloria Fernández-Esparrach

¹⁰Endoscopy Unit, Department of Gastroenterology, Hospital Clínic Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain

,

Antonio Facciorusso

¹Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy

¹⁵Department of Medical and Surgical Sciences, Section of Gastroenterology, University of Foggia, Foggia, Italy

,

Alberto Larghi

¹⁶Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

› Author Affiliations

Abstract

Background It is unknown whether there is an advantage to using the wet-suction or slow-pull technique during endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) with new-generation needles. We aimed to compare the performance of each technique in EUS-FNB.

Methods This was a multicenter, randomized, single-blind, crossover trial including patients with solid lesions of ≥ 1 cm. Four needle passes with 22 G fork-tip or Franseen-type needles were performed, alternating the wet-suction and slow-pull techniques in a randomized order. The primary outcome was the histological yield (samples containing an intact piece of tissue of at least 550 μm). Secondary end points were sample quality (tissue integrity and blood contamination), diagnostic accuracy, and adequate tumor fraction.

Results Overall, 210 patients with 146 pancreatic and 64 nonpancreatic lesions were analyzed. A tissue core was retrieved in 150 (71.4 %) and 129 (61.4 %) cases using the wet-suction and the slow-pull techniques, respectively (P = 0.03). The mean tissue integrity score was higher using wet suction (P = 0.02), as was the blood contamination of samples (P < 0.001). In the two subgroups of pancreatic and nonpancreatic lesions, tissue core rate and tissue integrity score were not statistically different using the two techniques, but blood contamination was higher with wet suction. Diagnostic accuracy and tumor fraction did not differ between the two techniques.

Conclusion Overall, the wet-suction technique in EUS-FNB resulted in a higher tissue core procurement rate compared with the slow-pull method. Diagnostic accuracy and the rate of samples with adequate tumor fraction were similar between the two techniques.

Full Text

References

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