Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline – March 2017

Abstract

This Guideline from the European Society of Gastrointestinal Endoscopy (ESGE) focuses on technical aspects of endoscopic ultrasonography (EUS)-guided sampling in gastroenterologythe choice of needle, sampling technique, and specimen handling and processing -and updates the previous guideline on these topics published in 2012 [1]. The target audience for this Guideline is endoscopists who perform EUS-guided sampling. Indications, results, and clinical impact of EUS-guided sampling are addressed in a separate clinical Guideline from ESGE [2].Guideline development process ESGE commissioned this Guideline and appointed a Guideline leader (J.M.D.) who invited the listed authors to participate in the project development. The key questions were prepared by the coordinating team (M.P., J.M.D.) and then approved by the other members. The coordinating team formulated key questions and assigned them to task force subgroups (Appendix e1 and Appendix e2, available online-only).Each task force performed a systematic literature search to prepare evidence-based and well-balanced statements on their assigned key questions. The literature search was performed in Medline through PubMed to identify new publications since ABBREVIATIONS CI confidence interval ESGE European Society of Gastrointestinal Endoscopy EUS endoscopic ultrasound FNA fine needle aspiration FNB fine needle biopsy G gauge GRADE Grading of Recommendations Assessment, Development and Evaluation LN lymph node RCT randomized controlled trial ROSE rapid on-site cytologic evaluation RECOMMENDATIONSFor routine EUS-guided sampling of solid masses and lymph nodes (LNs) ESGE recommends 25G or 22G needles (high quality evidence, strong recommendation); fine needle aspiration (FNA) and fine needle biopsy (FNB) needles are equally recommended (high quality evidence, strong recommendation).When the primary aim of sampling is to obtain a core tissue specimen, ESGE suggests using 19G FNA or FNB needles or 22G FNB needles (low quality evidence, weak recommendation). ESGE recommends using 10-mL syringe suction for EUSguided sampling of solid masses and LNs with 25G or 22G FNA needles (high quality evidence, strong recommendation) and other types of needles (low quality evidence, weak recommendation). ESGE suggests neutralizing residual negative pressure in the needle before withdrawing the needle from the target lesion (moderate quality evidence, weak recommendation). ESGE does not recommend for or against using the needle stylet for EUS-guided sampling of solid masses and LNs with FNA needles (high quality evidence, strong recommendation) and suggests using the needle stylet for EUSguided sampling with FNB needles (low quality evidence, weak recommendation). ESGE suggests fanning the needle throughout the lesion when sampling solid masses and LNs (moderate quality evidence, weak recommendation).ESGE equally recommends EUS-guided sampling with or without on-site cytologic evaluation (moderate quality evidence, strong recommendation GuidelineThis document was downloaded for person...

Impact of endoscopic ultrasound‐guided fine‐needle biopsy on the diagnosis of subepithelial tumors: A propensity score‐matching analysis

“…Endoscopic ultrasound (EUS)‐guided sampling is an established method of obtaining specimens for the pathological diagnosis of solid masses, including pancreatic tumors, subepithelial tumors (SET), and lymph node lesions . Two types of needles are used for EUS‐guided sampling with fine‐needle biopsy (FNB) and fine‐needle aspiration (FNA) needles .…”

“…Endoscopic ultrasound (EUS)‐guided sampling is an established method of obtaining specimens for the pathological diagnosis of solid masses, including pancreatic tumors, subepithelial tumors (SET), and lymph node lesions . Two types of needles are used for EUS‐guided sampling with fine‐needle biopsy (FNB) and fine‐needle aspiration (FNA) needles . FNB needles are designed to procure samples in a way that preserves the tissue architecture for histological evaluations; they feature either a particular cutting‐tip geometry or a beveled side hole in the distal portion of the needle .…”

The diagnostic performance of novel torque technique for endoscopic ultrasound‐guided tissue acquisition in solid pancreatic lesions: A prospective randomized controlled trial

“…The fanning technique allows for targeting multiple areas within the mass during each needle pass and hence reduces the chance of sampling error. Also, the technique is not associated with an additional risk or cost . However, the evidence is limited to one study in patients with pancreatic masses that showed advantages of fanning in terms of sample adequacy but failed to show a significant impact on diagnostic accuracy.…”

“…Also, the technique is not associated with an additional risk or cost . However, the evidence is limited to one study in patients with pancreatic masses that showed advantages of fanning in terms of sample adequacy but failed to show a significant impact on diagnostic accuracy. Finally, during back‐and‐forth thrusting movements, there could be a possibility of missing out visualization of the needle on new horizontal plane according to torqueing the scope body for targeting different area within the mass.…”

“…However, the diagnostic yield, including sensitivity and specificity (75–92% and 82–100%, respectively), for pancreatic solid mass is limited especially considering the very low negative predictive value . To overcome this limitation, some attempts for the improvement of diagnostic outcomes in EUS‐guided tissue acquisition were conducted; these include the use of fanning technique, the use or elimination of suction, and the use or elimination of stylet . Among these, the fanning technique was first introduced by Bang et al .…”