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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

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.

Supporting information



Publication History

Received: 29 March 2023

Accepted after revision: 17 August 2023

Accepted Manuscript online:
17 August 2023

Article published online:
24 November 2023

© 2023. Thieme. All rights reserved.

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