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

Abstract

Background Despite the widespread use of endoscopic ultrasound (EUS)-guided tissue acquisition, the choice of optimal suction technique remains a 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 studies 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 (OR) 0.50, 95% confidence interval (CI) 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 FNA needle. Surface under the cumulative ranking analysis ranked WS as the best modality for all the outcomes. Conclusion 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.

18F-Fluorodeoxyglucose-Avid Benign Anthracotic Mediastinal Lymphadenitis Mimicking Metastatic Lymphadenopathy

“…22-G FNA needles (Echotip Ultra, Cook Medical, Bloomington, Indiana) or 22-G FNB needles (Acquire needle®, Boston Scientific Corporation, Natick, Massachusetts) were employed. The number of passes and the suction technique were determined at the endoscopist's discretion [13]. Subsequently, the samples were sent for cytological and histopathological examination [14].…”

Role of Endoscopic Ultrasound in Diagnosis of Pancreatic Ductal Adenocarcinoma

“…In a recent network meta-analysis of 16 studies ( n = 2048), these techniques were compared (including no suctioning and the wet suction, dry suction, and stylet slow-pull techniques), and no difference among the various suction techniques was found in terms of their tissue adequacy, diagnostic accuracy, and moderate-to-high levels of cellularity. When adjusted for the effect of the type of needle used, no difference was found among these techniques in terms of the bloodiness of the sample [ 81 ]. So, the decision to use suctioning and the type of suctioning should be made using more of an individualized approach, depending on the type of lesion, presence of comorbidities, and operator experience.…”