A Pilot Randomized Crossover Trial of Wet Suction and Conventional Techniques of Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Upper Gastrointestinal Subepithelial Lesions

Abstract

Background and Aim. A wet suction technique (“wet” technique) has been developed to improve the quality of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for sampling various solid lesions. However, no studies have reported on the wet technique for EUS-FNA for gastrointestinal (GI) subepithelial lesions (SELs). We conducted a pilot randomized crossover trial to explore whether the wet technique could be useful with regard to tissue adequacy of upper GI-SELs (UGI-SELs) compared to the conventional EUS-FNA technique (“dry” technique). Methods. Twenty-six patients with UGI-SELs indicated for EUS-FNA were randomly assigned to the dry-first arm using the dry technique for the first two passes or the wet-first arm using the wet technique for the first two passes using a cross-over design with a ratio of 1 : 1. The primary endpoint was the cellularity score of the EUS-FNA specimens rated on a 4-point scale (0-3). The secondary endpoints were the factors influencing cellularity in each suction technique. Results. The mean cellularity score was 1.65 ± 1.20 for the wet technique and 2.00 ± 0.98 for the dry technique ( p = 0.068 ). Logistic regression analysis showed that higher cellularity may be related to the final diagnosis of gastrointestinal stromal tumors in the dry technique and the SEL location in the upper stomach in the wet technique. Conclusion. The wet EUS-FNA technique failed to show a potential for improved cellularity of specimens compared to the dry technique for UGI-SELs.

Usefulness of a Fork-Tip Needle in Endoscopic Ultrasound-Guided Fine-Needle Biopsy for Gastric Subepithelial Lesions

“…Among them, the wet suction method, in which the puncture needle is filled with saline, has been reported for pancreatic tumors as a method to maintain suction force [21][22][23]. However, in our previous study, there was no advantage of the wet suction method over the conventional method in EUS-FNA for gastric SELs [24]. Therefore, a method that does not rely on suction seems to be important for reliable tissue collection under EUS for gastric SELs.…”

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

“…Finally, 16 RCTs [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] with 2048 patients were included in the meta-analysis. Figure 1 shows the PRISMA diagram for study selection.…”

“…FNA needle was used in 9 studies [11][12][13][14]16,17,21,23,26] among which 7 studies used 22-G needle [11,13,16,17,21,23,26] and 2 studies used other size needles [12,14]. Seven studies used FNB needle [15,[18][19][20]22,24,25], among which only one study used 20-G needle [18] and the rest used 22-G needle.…”

“…The number of needle passes was two in majority of the studies [11,12,15,17,[19][20][21]23]. Six studies [15,16,20,[23][24][25] had moderate risk of bias while 10 studies had low risk of bias [11][12][13][14][17][18][19]21,22,26] (Supplementary Figure 1). The definitions of various outcomes used in the included studies in shown in supplementary Table 1.…”

“…6 studies [11,12,20,21,23,24] compared the outcomes of DS vs. WS. There was no difference between DS and WS for sample adequacy (6 RCTs; OR = 0.60, 95%CI [0.27 -1.34]; I 2 = 72%, p = 0.003), gross bloodiness (5 RCTs; OR = 1.93, 95%CI [0.85 -4.36]; I 2 = 69%, p = 0.01), moderate to highly cellular sample (6 RCTs; OR = 0.67, 95%CI [0.28 -1.58]; I 2 = 81%, p = 0.000), and diagnostic accuracy (3 RCTs; OR = 0.76, 95%CI [0.50 -1.16]; I 2 = 0.0%, p = 0.92).…”