A Meta-analysis of Slow Pull versus Suction for Endoscopic Ultrasound-Guided Tissue Acquisition

Abstract

Background/Aims: Endoscopic ultrasound (EUS)-guided tissue acquisition is widely utilized as a diagnostic modality for intra-abdominal masses, but there remains debate regarding which suction technique, slow pull (SP) or conventional suction (CS), is better. A meta-analysis of reported studies was conducted to compare the diagnostic yields of SP and CS during EUS-guided tissue acquisition. Methods: We conducted a systematic electronic search using MEDLINE/PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials to identify clinical studies comparing SP and CS. We meta-analyzed accuracy, sensitivity, blood contamination and cellularity using the random-effects model. Results: A total of 17 studies (seven randomized controlled trials, four prospective studies, and six retrospective studies) with 1,616 cases were included in the analysis. Compared to CS, there was a trend toward better accuracy (odds ratio [OR], 1.48; 95% confidence interval [CI], 0.97 to 2.27; p=0.07) and sensitivity (OR, 1.67; 95% CI, 0.95 to 2.93; p=0.08) with SP and a significantly lower rate of blood contamination (OR, 0.48; 95% CI, 0.33 to 0.69; p<0.01). However, there was no significant difference in cellularity between SP and CS, with an OR of 1.28 (95% CI, 0.68 to 2.40; p=0.45). When the use of a 25-gauge needle was analyzed, the accuracy and sensitivity of SP were significantly better than those of CS, with ORs of 4.81 (95% CI, 1.99 to 11.62; p<0.01) and 4.69 (95% CI, 1.93 to 11.40; p<0.01), respectively. Conclusions: Compared to CS, SP appears to provide better accuracy and sensitivity in EUSguided tissue acquisition, especially when a 25-gauge needle is used.

Endoscopic ultrasonography‐guided tissue acquisition for small solid pancreatic lesions: Does the size matter?

“…Recent FNB needles have various features to increase cellularity of the specimen, and the resistance at needle advancement should be evaluated in these new FNB needles. We previously reported the slow pull method was associated with the better diagnostic yield in a 25‐gauge FNA needle 50 and FNB needles 51 . Although the use of slow pull method was not associated with the better diagnostic yield in our meta‐analysis, the best suction technique for small SPLs remains to be clarified.…”

“…We previously reported the slow pull method was associated with the better diagnostic yield in a 25‐gauge FNA needle 50 and FNB needles. 51 Although the use of slow pull method was not associated with the better diagnostic yield in our meta‐analysis, the best suction technique for small SPLs remains to be clarified.…”

Comparison of suction techniques for EUS-guided tissue acquisition: Systematic review and network meta-analysis of randomized controlled trials

“…A previous meta-analysis by Nakai et al [8] reported that SSP was likely to provide lower blood contamination but similar cellularity and diagnostic accuracy compared to DS. However, ran-domized trials, studies using 25G needle and studies involving pancreatic lesions showed higher diagnostic accuracy with SSP than DS on sensitivity analysis.…”

Impact of Endoscopic Ultrasound-Guided Tissue Acquisition on Decision-Making in Precision Medicine for Pancreatic Cancer: Beyond Diagnosis

“…On the other hand, many reports suggest the absence of any significant difference in the diagnostic performance between the two techniques [ 65 , 66 , 67 , 68 , 69 , 70 ]. One meta-analysis concluded that, although there was no difference in the accuracy or sensitivity between the two techniques, use of the non-suction technique was associated with a significantly lower rate of blood contamination compared to use of the conventional suction technique [ 71 ].…”