• EUS
• EUS-FNA
• Endoscopic ultrasound
• Pancreatic cancer

Endoscopic ultrasonography (EUS)-guided tissue acquisition requires a long learning curve. We aimed to compare the skill maturation curves between fine needle aspiration (FNA) and biopsy (FNB) for tissue acquisition.

The initial 60 procedures performed by the trainee endosonographer (30 FNA vs. 30 FNB) were consecutively enrolled. The difference in procedure performance was compared between the two groups. Learning curves were assessed. Twenty additional cases were subsequently enrolled to assess the consistency of performance in the FNB group.

The FNB group acquired larger tissue samples (2.35 vs. 0.70 mm²; p<0.001) with lower blood content (p=0.001) and higher tissue quality (p=0.017) compared with the FNA group. In addition, the FNB group required less needle pass to establish a diagnosis (2.43 vs. 2.97; p=0.006). A threshold diagnostic sensitivity of ≥80% was achieved after performing 10 FNB procedures. The number of needle passes significantly decreased after conducting 20 FNB procedures (1.80 vs. 2.70; p=0.041). The diagnostic sensitivity and number of needle passes remained the same in the subsequent FNB procedures. By contrast, this skill maturation phenomenon was not observed after performing 30 FNA procedures.

In EUS-guided tissue acquisition, the FNB needle was more efficient and thus shortened the learning curve of EUS-guided tissue acquisition in trainee endosonographers.

• Core needle biopsy
• Endoscopic ultrasonography
• Fine needle aspiration
• Gastrointestinal endoscopes
• Programmed learning

The sensitivity of EUS-guided fine-needle biopsy (EUS-FNB) varies considerably. The optimal number of passes through a solid pancreatic lesion with a 22G FNB needle during EUS-FNB is controversial. This prospective randomized controlled study aimed to determine the optimal number of needle passes during EUS-FNB of solid pancreatic lesions, with 22G FNB needles and different sampling techniques.

Pancreatic masses were sampled using 22G FNB needles with either the stylet slow-pull (SP) technique or the standard-suction (SS) technique. We determined the number of needle passes required to obtain a diagnostic accuracy of >90%. Differences between the two techniques in terms of technical success rate, cytological acquisition, core tissue acquisition, sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and complications were analyzed.

A total of 120 patients were randomly assigned to either SP or SS group. Three patients who were lost to follow-up and one who did not complete 5 passes due to bent needle head were excluded from the study. Fifty-six cases in the SP group and 60 cases in the SS group were included in the analysis. For SP technique, the cumulative accuracy of passes 1, 2, 3, 4, and 5 was 44.83%, 76.79%, 87.50%, 92.86%, and 94.64%, respectively. For SS technique, the cumulative accuracy of passes 1, 2, 3, 4, and 5 was 71.67%, 85.0%, 90.0%, 93.33%, and 95.0%, respectively. For each group, there was no statistically significant difference in accuracy after 3 and 4 passes. After 4 passes, the pooled sensitivity (92.59% vs. 93.10%), accuracy (92.86% vs. 93.10%), and specificity (100% vs. 100%) were similar (P > 0.05) in the SP and SS groups, respectively. In addition, positive cytological diagnoses (83.9% vs. 85.0%) and positive histological diagnoses (71.4% vs. 78.3%) were comparable (P > 0.05) in the SP and SS groups, respectively. No statistically significant factor was found associated with diagnostic sensitivity for each group.

When on-site cytological evaluation is unavailable, we recommend that at least 3 passes with 22G ProCore needles be performed during EUS-FNB using the SS technique, at least 4 passes when using SP technique. The SS technique showed potential advantages over SP technique in tissue acquisition and diagnostic capabilities.

• EUS
• fine-needle biopsy
• solid pancreatic lesion

The role of endoscopic procedures, in both diagnostic and therapeutic purposes is continually expanding and evolving rapidly. In this context, endoscopists will encounter patients prescribed on anticoagulant and antiplatelet medications frequently. This poses an increased risk of intraprocedural and delayed gastrointestinal bleeding. Thus, there is now greater importance on optimal pre, peri and post-operative management of anticoagulant and/or antiplatelet therapy to minimise the risk of post-procedural bleeding, without increasing the risk of a thromboembolic event as a consequence of therapy interruption. Currently, there are position statements and guidelines from the major gastroenterology societies. These are available to assist endoscopists with an evidenced-based systematic approach to anticoagulant and/or antiplatelet management in endoscopic procedures, to ensure optimal patient safety. However, since the publication of these guidelines, there is emerging evidence not previously considered in the recommendations that may warrant changes to our current clinical practices. Most notably and divergent from current position statements, is a growing concern regarding the use of heparin bridging therapy during warfarin cessation and its associated risk of increased bleeding, suggestive that this practice should be avoided. In addition, there is emerging evidence that anticoagulant and/or antiplatelet therapy may be safe to be continued in cold snare polypectomy for small polyps (< 10 mm).

• Endoscopy
• Anticoagulants
• Antiplatelets
• Antithrombotics
• Bleeding
• Gastrointestinal

• endoscopic ultrasound-guided fine needle aspiration
• sarcoidosis
• splenic sarcoidosis

• Aged
• Bronchoscopy/methods
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods
• Humans
• Male
• Sarcoidosis/diagnosis
• Sarcoidosis/pathology
• Splenic Diseases/diagnosis
• Splenic Diseases/pathology

• Biopsy
• Complication
• EUS
• Pancreas
• meta-Analysis

• complication
• diagnostic sensitivity
• endoscopic ultrasound-guided fine needle aspiration
• prospective cohort study
• solid pancreatic lesion

EUS-guided tissue acquisition (EUS-TA) has made rapid development since its introduction in the early 1990s. The technique is widely accepted and invaluable for staging and diagnosis of a variety of upper gastrointestinal and mediastinal lesions. Fine-needle aspiration (FNA) has long been the gold standard, but due to its limitations such as the inability to retain stroma and associated cellular architecture, novel biopsy needles (FNB) were designed. Overall, FNA and FNB needles perform seemingly equally in terms of diagnostic accuracy, however, the second-generation FNB needles require less passes. The third-generation FNB needles (crown-cut needle types) seem to be preferable to FNA needles as well as to the second-generation FNB needles, when larger histological specimens and preserved tissue architecture are required. EUS-TA is constantly under development, and new applications of this technique include tumor risk stratification according to its genetic profile as well as minimally invasive creation of patient-derived organoids, hallmarks of personized medicine. It remains yet to be shown, whether these applications will lead to a decisive shift from aspiration to biopsy, i.e., from A to B.

• EUS
• FNA
• fine-needle biopsy
• pancreas

• FNA
• FNB
• interobserver agreement
• pathology

• Clinical Competence
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods
• Endosonography/methods
• Humans
• Pancreas/diagnostic imaging
• Pancreatic Neoplasms/diagnosis
• Pathologists/standards
• ROC Curve
• Reproducibility of Results

• UL1 TR001863 NCATS NIH HHS
• EUDRT05-09-2013 Cook Medical Devices

• Core tissue
• Endosonography
• Pancreatic neoplasm
• Tissue sampling

• Biliary drainage
• Roux-en-Y gastric bypass anatomy
• peripancreatic collection
• targeted angiotherapy

• EUS
• Endoscopic ultrasound
• Endoscopic ultrasound-guided fine needle aspiration
• Forward-cutting bevel needle
• Pancreatic cancer

• pancreatic cancer
• endoscopic ultrasonography
• fine needle aspiration biopsies

• Data Accuracy
• Efficiency
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/instrumentation
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/standards
• Humans
• Likelihood Functions
• Needles/standards
• Pancreas/pathology
• Pancreatic Neoplasms/diagnostic imaging
• Pancreatic Neoplasms/pathology
• Randomized Controlled Trials as Topic
• Sensitivity and Specificity

• Diagnostic Imaging/methods
• Elasticity Imaging Techniques
• Endoscopic Ultrasound-Guided Fine Needle Aspiration
• Endosonography
• Humans
• Magnetic Resonance Imaging
• Pancreatic Diseases/diagnostic imaging
• Pancreatic Neoplasms/diagnostic imaging
• Positron-Emission Tomography
• Precancerous Conditions/diagnostic imaging
• Sensitivity and Specificity
• Tomography, X-Ray Computed

• 10/4001/11 Department of Health
• 13/89/03 Department of Health
• PB-PG-0712-28114 Department of Health
• RG2014_01_PERERIA Pancreatic Cancer UK

• Anticoagulant agents
• antiplatelet agents
• antithrombotic agents
• bleeding
• endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA)

• Angulated
• Biliary drainage
• Drainage
• Endosonography
• Flexible 19-G needle
• Interventional endoscopic ultrasound
• Pancreatic fluid collection
• Therapeutic endoscopic ultrasound

Pancreatic cancer is the fifth leading cause of cancer death and has the lowest survival rate of any solid cancer. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) is currently capable of providing a cytopathological diagnosis of pancreatic malignancies with a higher diagnostic power, with a sensitivity and specificity of 85%-89% and 98%-99%, compared to pancreatic juice cytology (PJC), whose sensitivity and specificity are only 33.3%-93% and 83.3%-100%. However, EUS-FNA is not effective in the cases of carcinoma in situ and minimally invasive carcinoma because both are undetectable by endoscopic ultrasonography, although PJC is able to detect them. As for the frequency of complications such as post endoscopic retrograde cholangiopancreatography pancreatitis, EUS-FNA is safer than PJC. To diagnose pancreatic cancer appropriately, it is necessary for us to master both procedures so that we can select the best methods of sampling tissues while considering the patient’s safety and condition.

• Endoscopic ultrasound-guided fine-needle aspiration biopsy
• Cytology
• Pathology
• Pancreatic juice cytology
• Pancreatic cancer

• diagnostic accuracy
• endoscopic ultrasound-guided fine-needle aspiration
• pancreatic tumors

Endoscopic ultrasound (EUS)-guided tissue acquisition has emerged over the last decade as an invaluable diagnostic tool in approaching the different pancreatic lesions. Given the safety and minimal invasiveness of this approach combined with the high diagnostic yield, it became the standard of care when dealing with different pancreatic pathologies. However, some variables regarding this procedure remain not fully understood. These can influence the diagnostic yield of the procedure and include the presence of the on-site cytopathologist, the type and size of the needle used as well as obtaining aspiration versus core biopsy, the number of passes and the sampling technique, and the role of suction and stylet use among others. We performed a comprehensive literature search using PubMed, Google Scholar, and Embase for studies that assessed these variables. Eligible studies were analyzed using several parameters such as technique and procedure, with the aim of reviewing results from an evidence-based standpoint.

• Cytopathology
• endoscopic ultrasound (EUS)
• fine-needle aspiration (FNA)
• fine-needle biopsy (FNB)
• pancreatic lesions

Endoscopic ultrasound-guided fine needle core biopsy (EUS-FNB) has been used as an effective method of diagnosing pancreatic malignant lesions. It has the advantage of providing well preserved tissue for histologic grading and subsequent molecular biological analysis. In order to estimate the diagnostic accuracy of EUS-FNB for pancreatic malignant lesions, studies assessing EUS-FNB to diagnose solid pancreatic masses were selected via Medline. Sixteen articles published between 2005 and 2015, covering 828 patients, met the inclusion criteria. The summary estimates for EUS-FNB differentiating malignant from benign solid pancreatic masses were: sensitivity 0.84 (95% confidence interval (CI), 0.82–0.87); specificity 0.98 (95% CI, 0.93–1.00); positive likelihood ratio 8.0 (95% CI 4.5–14.4); negative likelihood ratio 0.17 (95% CI 0.10–0.26); and DOR 64 (95% CI 30.4–134.8). The area under the sROC curve was 0.96. Subgroup analysis did not identify other factors that could substantially affect the diagnostic accuracy, such as the study design, location of study, number of centers, location of lesion, whether or not a cytopathologist was present, and so on. EUS-FNB is a reliable diagnostic tool for solid pancreatic masses and should be especially considered for pathology where histologic morphology is preferred for diagnosis.

• Endoscopic ultrasound
• Intraductal papillary mucinous neoplasm
• Mucinous cystadenoma
• Needle-based confocal laser endomicroscopy
• Pancreatic cancer
• Pancreatic cyst
• Serous cystadenoma

• Diagnosis, Differential
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/adverse effects
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods
• Humans
• Image Interpretation, Computer-Assisted
• Microscopy, Confocal/methods
• Observer Variation
• Pancreatic Cyst/pathology
• Predictive Value of Tests
• Prognosis
• Reproducibility of Results

Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been applied to pancreaticobiliary lesions since the 1990s and is in widespread use throughout the world today. We used this method to confirm the pathological evidence of the pancreaticobiliary lesions and to perform suitable therapies. Complications of EUS-FNA are quite rare, but some of them are severe. Operators should master conventional EUS observation and experience a minimum of 20-30 cases of supervised EUS-FNA on non-pancreatic and pancreatic lesions before attempting solo EUS-FNA. Studies conducted on pancreaticobiliary EUS-FNA have focused on selection of suitable instruments (e.g., needle selection) and sampling techniques (e.g., fanning method, suction level, with or without a stylet, optimum number of passes). Today, the diagnostic ability of EUS-FNA is still improving; the detection of pancreatic cancer (PC) currently has a sensitivity of 90%-95% and specificity of 95%-100%. In addition to PC, a variety of rare pancreatic tumors can be discriminated by conducting immunohistochemistry on the FNA materials. A flexible, large caliber needle has been used to obtain a large piece of tissue, which can provide sufficient histological information to be helpful in classifying benign pancreatic lesions. EUS-FNA can supply high diagnostic yields even for biliary lesions or peri-pancreaticobiliary lymph nodes. This review focuses on the clinical aspects of EUS-FNA in the pancreaticobiliary field, with the aim of providing information that can enable more accurate and efficient diagnosis.

• Endoscopic ultrasonography-guided fine-needle aspiration
• Diagnosis
• Pancreaticobiliary
• Pancreatic
• Cancer

• Biliary Tract Neoplasms/pathology
• Biliary Tract Neoplasms/therapy
• Clinical Competence
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/adverse effects
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/instrumentation
• Equipment Design
• Humans
• Learning Curve
• Needles
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/therapy
• Predictive Value of Tests
• Prognosis
• Reproducibility of Results
• Risk Factors