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Endoscopy 2024; 56(01): 31-40
DOI: 10.1055/a-2156-0063
Systematic review

Comparative diagnostic yield of different endoscopic techniques for tissue sampling of upper gastrointestinal subepithelial lesions: a network meta-analysis

Authors

  • Antonio Facciorusso

    1   Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy (Ringgold ID: RIN18972)

  • Stefano Francesco Crinò

    2   Gastroenterology and Digestive Endoscopy Unit, Department of Medicine, The Pancreas Institute, University Hospital of Verona, Verona, Italy

  • Alessandro Fugazza 

    3   Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy
    4   Department of Biomedical Sciences, Humanitas University, Milan, Italy

  • Silvia Carrara

    3   Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy
    4   Department of Biomedical Sciences, Humanitas University, Milan, Italy

  • Marco Spadaccini

    3   Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy
    4   Department of Biomedical Sciences, Humanitas University, Milan, Italy

  • Matteo Colombo

    3   Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy
    4   Department of Biomedical Sciences, Humanitas University, Milan, Italy

  • Daryl Ramai

    5   Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, United States (Ringgold ID: RIN12348)

  • Benedetto Mangiavillano

    6   Gastrointestinal Endoscopy Unit, Humanitas – Mater Domini, Castellanza, Italy

  • Saurabh Chandan

    7   Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, United States (Ringgold ID: RIN6216)

  • Paraskevas Gkolfakis

    8   Department of Gastroenterology, “Konstantopouleion-Patision” General Hospital of Nea Ionia, Athens, Greece

  • Babu Mohan

    5   Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, United States (Ringgold ID: RIN12348)

  • Cesare Hassan

    3   Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy
    4   Department of Biomedical Sciences, Humanitas University, Milan, Italy

  • Alessandro Repici

    3   Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy
    4   Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Abstract

Background There is limited evidence on the comparative diagnostic performance of endoscopic tissue sampling techniques for subepithelial lesions. We performed a systematic review with network meta-analysis to compare these techniques.

Methods A systematic literature review was conducted for randomized controlled trials (RCTs) comparing the sample adequacy and diagnostic accuracy of bite-on-bite biopsy, mucosal incision-assisted biopsy (MIAB), endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), and EUS-guided fine-needle biopsy (FNB). Results were expressed as relative risk (RR) and 95%CI.

Results Eight RCTs were identified. EUS-FNB was significantly superior to EUS-FNA in terms of sample adequacy (RR 1.20 [95%CI 1.05–1.45]), whereas none of the other techniques significantly outperformed EUS-FNA. Additionally, bite-on-bite biopsy was significantly inferior to EUS-FNB (RR 0.55 [95%CI 0.33–0.98]). Overall, EUS-FNB appeared to be the best technique (surface under cumulative ranking [SUCRA] score 0.90) followed by MIAB (SUCRA 0.83), whereas bite-on-bite biopsy showed the poorest performance. When considering lesions <20 mm, MIAB, but not EUS-FNB, showed significantly higher accuracy rates compared with EUS-FNA (RR 1.68 [95%CI 1.02–2.88]). Overall, MIAB ranked as the best intervention for lesions <20 mm (SUCRA score 0.86 for adequacy and 0.91 for accuracy), with EUS-FNB only slightly superior to EUS-FNA. When rapid on-site cytological evaluation (ROSE) was available, no difference between EUS-FNB, EUS-FNA, and MIAB was observed.

Conclusion EUS-FNB and MIAB appeared to provide better performance, whereas bite-on-bite sampling was significantly inferior to the other techniques. MIAB seemed to be the best option for smaller lesions, whereas EUS-FNA remained competitive when ROSE was available.

Supplementary Material



Publikationsverlauf

Eingereicht: 29. März 2023

Angenommen nach Revision: 17. August 2023

Accepted Manuscript online:
17. August 2023

Artikel online veröffentlicht:
24. November 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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