Which needle device is accessible in endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA), needle with Coil-spring sheath or Teflon sheath? A randomized prospective comparative study

Background: Nowadays, EUS-FNA needle devices with two kinds of sheaths, Coil-spring and Teflon, are available. Although the needle with Coil-spring sheath is easy to pass in working channel of echoendoscope, we had a few experiences that it bent and brought about dislocation during EUS-FNA for hard lesions. Therefore, we conducted comparative study of the usability of two needle devices; Coil-spring sheath and Teflon sheath.

Methods: Among patients undergoing EUS-FNA between January and September 2008, 25 patients submitting consent were enrolled in this study. Each target lesion was punctured twice alternately with a needle device with Coil-spring sheath (C needle, ECHO-3–22, Wilson-Cook) and that with Teflon sheath (T needle, ECHO-1–22, Wilson-Cook). Usability was evaluated using 4-point scale on the basis of the four items as follows; 1) smoothness of passage in the working channel, 2) easiness of puncture, 3) easiness of the needle movement in the target lesion, 4) visibility of the needle during endoscopic ultrasonography.

Results: The punctured lesions were solid pancreatic mass in 10 patients, gastrointestinal submucosal lesion in 9 (2 esophagus and 7 stomach), mediastinal mass in 3, and abdominal mass in 3. These lesions were punctured via esophagus in 5 patients via stomach in 18, and via duodenum in 2. The mean size of the lesions was 30mm. Evaluation results based on the four items were as follows; 1) smoothness of the passage in the working channel: T needle was superior in 3 patients, C needle was superior in 6, and equivalent in 16. The median was 4 points in both needles. 2) easiness of puncture: T needle was superior in 3 patients, C needle was superior in 4, and equivalent in 18. The median was 4 points in T needle and 3.5 points in C needle. 3) easiness of the needle movement in the target lesion: T needle was superior in 2 patients, C needle was superior in 2, and equivalent in 21. The median was 4 points in both needles. 4) visibility of the needle during endoscopic ultrasonography: T needle was superior in 5 patients, C needle was superior in 1, and equivalent in 19. The median was 4 points in T needle and 3.5 point in C needle.

Conclusion: This study demonstrated that the two needle devices with Coil-spring sheath and that with Teflon sheath were both accessible and had no significant difference with regard to the usability in EUS-FNA.