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Endoscopy 2023; 55(03): 225-234
DOI: 10.1055/a-1915-1812
Original article

Wet-suction versus slow-pull technique for endoscopic ultrasound-guided fine-needle biopsy: a multicenter, randomized, crossover trial

Stefano Francesco Crinò 
 1   Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
,
Maria Cristina Conti Bellocchi
 1   Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
,
Roberto Di Mitri
 2   Gastroenterology and Endoscopy Unit, Arnas Civico Di Cristina Benfratelli Hospital, Palermo, Italy
,
Frediano Inzani
 3   Pathology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Mihai Rimbaș
 4   Gastroenterology Department, Clinic of Internal Medicine, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania
,
Andrea Lisotti 
 5   Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
,
Guido Manfredi
 6   Gastroenterology and Digestive Endoscopy Department, ASST Ospedale Maggiore Crema, Crema, Italy
,
Anthony Y. B. Teoh 
 7   Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
,
Benedetto Mangiavillano 
 8   Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy
 9   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
,
Oriol Sendino
10   Endoscopy Unit, Department of Gastroenterology, Hospital Clínic Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
,
Laura Bernardoni
 1   Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
,
Erminia Manfrin
11   Department of Diagnostics and Public Health, G.B. Rossi University Hospital, Verona, Italy
,
Daniela Scimeca 
 2   Gastroenterology and Endoscopy Unit, Arnas Civico Di Cristina Benfratelli Hospital, Palermo, Italy
,
Elettra Unti
12   Pathology Unit, ARNAS Civico Di Cristina Benfratelli Hospital, Palermo, Italy
,
Angela Carlino
 3   Pathology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
,
Theodor Voiosu
 4   Gastroenterology Department, Clinic of Internal Medicine, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania
,
R. Bogdan Mateescu
 4   Gastroenterology Department, Clinic of Internal Medicine, Colentina Clinical Hospital, Carol Davila University of Medicine, Bucharest, Romania
,
Pietro Fusaroli 
 5   Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
,
Stefania Lega
13   Pathology Unit, Hospital of Imola, Imola, Italy
,
Elisabetta Buscarini
 6   Gastroenterology and Digestive Endoscopy Department, ASST Ospedale Maggiore Crema, Crema, Italy
,
Lorena Pergola
14   Pathology Department, ASST Ospedale Maggiore Crema, Crema, Italy
,
Shannon M. Chan 
 7   Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
,
Laura Lamonaca 
 8   Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Italy
,
Àngels Ginès
10   Endoscopy Unit, Department of Gastroenterology, Hospital Clínic Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
,
Gloria Fernández-Esparrach
10   Endoscopy Unit, Department of Gastroenterology, Hospital Clínic Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
,
Antonio Facciorusso 
 1   Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy
15   Department of Medical and Surgical Sciences, Section of Gastroenterology, University of Foggia, Foggia, Italy
,
Alberto Larghi
16   Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
› Author AffiliationsTrial Registration: ClinicalTrials.gov Registration number (trial ID): NCT04834193 Type of study: Prospective, randomized, multi-center, cross-over study
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Author commentary on Stefano Francesco Crinò et al.Endoscopy 2023; 55(03): v7-v7
DOI: 10.1055/a-1944-8392

Abstract

Background It is unknown whether there is an advantage to using the wet-suction or slow-pull technique during endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) with new-generation needles. We aimed to compare the performance of each technique in EUS-FNB.

Methods This was a multicenter, randomized, single-blind, crossover trial including patients with solid lesions of ≥ 1 cm. Four needle passes with 22 G fork-tip or Franseen-type needles were performed, alternating the wet-suction and slow-pull techniques in a randomized order. The primary outcome was the histological yield (samples containing an intact piece of tissue of at least 550 μm). Secondary end points were sample quality (tissue integrity and blood contamination), diagnostic accuracy, and adequate tumor fraction.

Results Overall, 210 patients with 146 pancreatic and 64 nonpancreatic lesions were analyzed. A tissue core was retrieved in 150 (71.4 %) and 129 (61.4 %) cases using the wet-suction and the slow-pull techniques, respectively (P = 0.03). The mean tissue integrity score was higher using wet suction (P = 0.02), as was the blood contamination of samples (P < 0.001). In the two subgroups of pancreatic and nonpancreatic lesions, tissue core rate and tissue integrity score were not statistically different using the two techniques, but blood contamination was higher with wet suction. Diagnostic accuracy and tumor fraction did not differ between the two techniques.

Conclusion Overall, the wet-suction technique in EUS-FNB resulted in a higher tissue core procurement rate compared with the slow-pull method. Diagnostic accuracy and the rate of samples with adequate tumor fraction were similar between the two techniques.



Publication History

Received: 10 April 2022

Accepted after revision: 01 August 2022

Accepted Manuscript online:
01 August 2022

Article published online:
27 September 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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