Abstract
Background and study aims Despite the widespread use of
endoscopic ultrasound (EUS)-guided tissue acquisition, the choice of optimal suction
technique
remains a subject of debate. Multiple studies have shown conflicting results with
respect to
the four suction techniques: Dry suction (DS), no suction (NS), stylet slow-pull (SSP)
and wet
suction (WS). Thus, the present network meta-analysis (NMA) was conducted to compare
the
diagnostic yields of above suction techniques during EUS-guided tissue acquisition.
Methods A comprehensive literature search from 2010 to March 2022
was done for randomized trials comparing the aspirated sample and diagnostic outcome
with
various suction techniques. Both pairwise and network meta-analyses were performed
to analyze
the outcomes: sample adequacy, moderate to high cellularity, gross bloodiness and
diagnostic
accuracy.
Results A total of 16 studies (n=2048 patients) were included in
the final NMA. WS was associated with a lower odd of gross bloodiness compared to
DS (odds
ratio 0.50, 95% confidence interval 0.24–0.97). There was no significant difference
between
the various suction methods with respect to sample adequacy, moderate to high cellularity
and
diagnostic accuracy. On meta-regression, to adjust for the effect of needle type,
WS was
comparable to DS in terms of bloodiness when adjusted for fine-needle aspiration needle.
Surface under the cumulative ranking analysis ranked WS as the best modality for all
the
outcomes.
Conclusions The present NMA did not show superiority of any
specific suction technique for EUS-guided tissue sampling with regard to sample quality
or
diagnostic accuracy, with low confidence in estimates.
