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

Antonio Facciorusso; Stefano Francesco Crinò; Alessandro Fugazza; Silvia Carrara; Marco Spadaccini; Matteo Colombo; Daryl Ramai; Benedetto Mangiavillano; Saurabh Chandan; Paraskevas Gkolfakis; Babu Mohan; Cesare Hassan; Alessandro Repici

doi:10.1055/a-2156-0063

Endoscopy, Table of Contents

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

Antonio Facciorusso

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

,

Stefano Francesco Crinò

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

,

Alessandro Fugazza

³Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy

⁴Department of Biomedical Sciences, Humanitas University, Milan, Italy

,

Silvia Carrara

³Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy

⁴Department of Biomedical Sciences, Humanitas University, Milan, Italy

,

Marco Spadaccini

³Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy

⁴Department of Biomedical Sciences, Humanitas University, Milan, Italy

,

Matteo Colombo

³Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy

⁴Department of Biomedical Sciences, Humanitas University, Milan, Italy

,

Daryl Ramai

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

,

Benedetto Mangiavillano

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

,

Saurabh Chandan

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

,

Paraskevas Gkolfakis

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

,

Babu Mohan

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

,

Cesare Hassan

³Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy

⁴Department of Biomedical Sciences, Humanitas University, Milan, Italy

,

Alessandro Repici

³Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy

⁴Department of Biomedical Sciences, Humanitas University, Milan, Italy

› Author Affiliations

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.

Full Text

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Supplementary Material

Supplementary Material