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
Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
Division of Gastroenterology, Department of Medicine, Royal Prince Alfred Hospital, Sydney, Australia
,
Mohamad El Zein
Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Tyler Stevens
Division of Gastroenterology, Department of Medicine, Royal Prince Alfred Hospital, Sydney, Australia
,
Ahmed Abdelgelil
Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Sepideh Besharati
Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Ahmed Messallam
Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Vivek Kumbhari
Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Alba Azola
Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Jennifer Brainard
Digestive Disease Institute, Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, United States
Pathology and Laboratory Medicine Institute, Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, United States
,
Eun Ji Shin
Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Anne Marie Lennon
Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Marcia I. Canto
Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Vikesh K. Singh
Division of Gastroenterology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Mouen A. Khashab
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.