Endoscopy
DOI: 10.1055/s-0043-119219
Guideline
© Georg Thieme Verlag KG Stuttgart · New York

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

Marcin Polkowski1, 2, Christian Jenssen3, Philip Kaye4, Silvia Carrara5, Pierre Deprez6, Angels Gines7, Gloria Fernández-Esparrach7, Pierre Eisendrath8, Guruprasad P. Aithal4, Paolo Arcidiacono9, Marc Barthet10, Pedro Bastos11, Adele Fornelli12, Bertrand Napoleon13, Julio Iglesias-Garcia14, Andrada Seicean15, Alberto Larghi16, Cesare Hassan16, Jeanin E. van Hooft17, Jean-Marc Dumonceau18
  • 1Department of Gastroenterology, Hepatology, and Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland
  • 2Department of Gastroenterological Oncology, The M. Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland
  • 3Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Academic Teaching Hospital of the Medical University of Brandenburg, Germany
  • 4Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, UK
  • 5Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Rozzano, Italy
  • 6Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
  • 7Endoscopy Unit, Department of Gastroenterology, ICMDM, IDIBAPS, CIBEREHD, Hospital Clínic, Barcelona, Spain
  • 8Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Université Libre de Bruxelles, Hôpital Erasme & Hôpital Saint-Pierre, Brussels, Belgium
  • 9Pancreato-Biliary Endoscopy and Endosonography Division, San Raffaele University, Milan, Italy
  • 10Service de Gastroentérologie, Hôpital NORD AP-HM, Aix-Marseille-Université, Marseille, France
  • 11Gastroenterology Department Instituto Português de Oncologia do Porto, Porto, Portugal
  • 12Anatomic Pathology Unit, AUSL of Bologna, Maggiore Hospital, Bologna, Italy
  • 13Department of Gastroenterology, Ramsay Générale de Santé, Private Hospital Jean Mermoz, Lyon, France
  • 14Gastroenterology Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
  • 15Regional Institute of Gastroenterology and Hepatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
  • 16Digestive Endoscopy Unit, Catholic University, Rome, Italy
  • 17Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
  • 18Gedyt Endoscopy Center, Buenos Aires, Argentina
Further Information

Publication History

Publication Date:
12 September 2017 (eFirst)

RECOMMENDATIONS

For 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 EUS-guided 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 EUS-guided 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). When on-site cytologic evaluation is unavailable, ESGE suggests performance of three to four needle passes with an FNA needle or two to three passes with an FNB needle (low quality evidence, weak recommendation).

For diagnostic sampling of pancreatic cystic lesions without a solid component, ESGE suggests emptying the cyst with a single pass of a 22G or 19G needle (low quality evidence, weak recommendation). For pancreatic cystic lesions with a solid component, ESGE suggests sampling of the solid component using the same technique as in the case of other solid lesions (low quality evidence, weak recommendation).

ESGE does not recommend antibiotic prophylaxis for EUS-guided sampling of solid masses or LNs (low quality evidence, strong recommendation), and suggests antibiotic prophylaxis with fluoroquinolones or beta-lactam antibiotics for EUS-guided sampling of cystic lesions (low quality evidence, weak recommendation).

ESGE suggests that evaluation of tissue obtained by EUS-guided sampling should include histologic preparations (e. g., cell blocks and/or formalin-fixed and paraffin-embedded tissue fragments) and should not be limited to smear cytology (low quality evidence, weak recommendation).

Appendix e1, e2 and Supplementary material Table s1 – s14