Endoscopy 2018; 50(05): 497-504
DOI: 10.1055/s-0043-122381
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Stylet slow-pull versus standard suction for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic lesions: a multicenter randomized trial

Payal Saxena
1  Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
2  Division of Gastroenterology, Department of Medicine, Royal Prince Alfred Hospital, Sydney, Australia
,
Mohamad El Zein
1  Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Tyler Stevens
2  Division of Gastroenterology, Department of Medicine, Royal Prince Alfred Hospital, Sydney, Australia
,
Ahmed Abdelgelil
1  Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Sepideh Besharati
1  Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Ahmed Messallam
1  Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Vivek Kumbhari
1  Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Alba Azola
1  Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Jennifer Brainard
3  Digestive Disease Institute, Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, United States
4  Pathology and Laboratory Medicine Institute, Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, United States
,
Eun Ji Shin
1  Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Anne Marie Lennon
1  Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Marcia I. Canto
1  Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Vikesh K. Singh
1  Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Mouen A. Khashab
1  Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
› Author Affiliations
TRIAL REGISTRATION: Multi-center single-blinded randomized clinical trial NCT01936467 at clinicaltrials.gov
Further Information

Publication History

submitted 05 June 2016

accepted after revision 10 October 2017

Publication Date:
22 December 2017 (eFirst)

Abstract

Background and study aim Standard endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) procedures involve use of no-suction or suction aspiration techniques. A new aspiration method, the stylet slow-pull technique, involves slow withdrawal of the needle stylet to create minimum negative pressure. The aim of this study was to compare the sensitivity of EUS-FNA using stylet slow-pull or suction techniques for malignant solid pancreatic lesions using a standard 22-gauge needle.

Patients and methods Consecutive patients presenting for EUS-FNA of pancreatic mass lesions were randomized to the stylet slow-pull or suction techniques using a 22-gauge needle. Both techniques were standardized for each pass until an adequate specimen was obtained, as determined by rapid on-site cytology examination. Patients were crossed over to the alternative technique after four nondiagnostic passes.

Results Of 147 patients screened, 121 (mean age 64 ± 13.8 years) met inclusion criteria and were randomized to the stylet slow-pull technique (n = 61) or the suction technique (n = 60). Technical success rates were 96.7 % and 98.3 % in the slow-pull and suction groups, respectively (P > 0.99). The sensitivity for malignancy of EUS-FNA was 82 % in the slow-pull group and 69 % in the suction group (P = 0.10). The first-pass diagnostic rate (42.6 % vs. 38.3 %; P = 0.71), acquisition of core tissue (60.6 % vs. 46.7 %; P = 0.14), and the median (range) number of passes to diagnosis (2 [1] [2] [3] vs. 1 [1] [2]; P = 0.71) were similar in the slow-pull and suction groups, respectively.

Conclusions The stylet slow-pull and suction techniques both offered high and comparable diagnostic sensitivity with a mean of 2 passes required for diagnosis of solid pancreatic lesions. The endosonographer may choose either technique during FNA.