Evaluating the safety and diagnostic performance of endoscopic ultrasound-guided fine-needle biopsy in the geriatric population

doi:10.4253/wjge.v18.i1.115392

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World Journal of Gastrointestinal Endoscopy

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1948-5190

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Endosc. Jan 16, 2026; 18(1): 115392
Published online Jan 16, 2026. doi: 10.4253/wjge.v18.i1.115392

Evaluating the safety and diagnostic performance of endoscopic ultrasound-guided fine-needle biopsy in the geriatric population

Zahabia Sohail, Aisha Jamal, Masood Muhammad Karim, Syedda Ayesha, Abdul Hadi Shahid, Muhammad Bazil Musharraf, Zeeshan Uddin, Adeel Ur Rehman

Zahabia Sohail, Aisha Jamal, Masood Muhammad Karim, Syedda Ayesha, Adeel Ur Rehman, Section of Gastroenterology, Department of Medicine, Aga Khan University, Karachi 74800, Sindh, Pakistan

Abdul Hadi Shahid, Medical College, Aga Khan University, Karachi 74800, Sindh, Pakistan

Muhammad Bazil Musharraf, Centre of Excellence for Trauma and Emergency, Aga Khan University, Karachi 74800, Sindh, Pakistan

Zeeshan Uddin, Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi 74800, Sindh, Pakistan

Co-first authors: Zahabia Sohail and Aisha Jamal.

Author contributions: Sohail Z and Jamal A contribute equally to this study as co-first authors; Sohail Z played a significant role in identifying the topic, shaping the project's conception and design, conducting literature search, and drafting the manuscript; Jamal A contributed to the project's conception and design, collecting and analysing data, and helped structure the manuscript; Karim MM assisted in shaping the project's conception and design, provided valuable insights into the data, cleaned the data, and wrote the manuscript; Ayesha S assisted in shaping the project's conception and design, helped in collecting the data and structuring the manuscript; Shahid AH assisted in shaping the project's conception and design, conducting a literature search, analysing the data, and structuring the manuscript; Musharraf MB contributed to collecting the data and structuring the manuscript; Uddin Z played a substantial role in interpreting the findings of fine-needle biopsy and histological slides and proofreading the manuscript; Rehman AU supervised the project, interpreting the findings, provided a critical review, made final edits, and ensured its accuracy and clarity with his expertise.

Institutional review board statement: This study was reviewed and approved as exemption by the institutional ethical review committee of Aga Khan University Hospital (Approval No. 6874-25427).

Informed consent statement: Informed consent from patients was exempted in this study, as approved by the institutional ethical review committee of Aga Khan University Hospital, because the study did not involve any direct human interaction and utilized data obtained after each patient had provided written consent for treatment. Furthermore, all patient identifiers were eliminated during data entry, and patient confidentiality was fully maintained.

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

Data sharing statement: The datasets generated and/or analysed during the current study are not publicly available owing to confidentiality and institutional ethical policies but can be received from the corresponding author upon reasonable request.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Adeel Ur Rehman, Assistant Professor, Section of Gastroenterology, Department of Medicine, Aga Khan University, National Stadium Road P.O. Box 3500, Karachi 74800, Sindh, Pakistan. rehman.adeel@aku.edu

Received: October 17, 2025
Revised: November 6, 2025
Accepted: November 25, 2025
Published online: January 16, 2026
Processing time: 91 Days and 13.6 Hours

Abstract

BACKGROUND

Endoscopic ultrasound (EUS) has emerged as a key diagnostic and therapeutic modality due to its minimally invasive nature and high success rates. It is widely used for diagnosing and staging gastrointestinal (GI), pancreatobiliary, and lung malignancies. EUS-guided fine needle biopsy (EUS-FNB) provides preserved tissue architecture, improving histological diagnosis for such conditions. The elderly are at significantly higher risk of GI lesions, being ten times more prone to malignancy and experiencing higher mortality, thereby requiring safer and less invasive diagnostic approaches. Despite its increasing use, evidence on EUS-FNB safety and diagnostic yield in geriatric population, particularly from resource-limited settings, remains limited.

AIM

To assess the indications, diagnostic efficacy, and safety profile of EUS-FNB in the geriatric population.

METHODS

This single-centre retrospective study included patients aged 65 years or above who underwent EUS-guided biopsy between June 2020 and June 2022 at Aga Khan University Hospital, a tertiary care centre in Karachi, Pakistan. Patient demographics, procedural details including lesion site, number of needle passes, needle type, and tissue acquisition technique, along with histopathological diagnosis, were extracted from medical records. Data were analysed using SPSS, with categorical variables reported as frequencies and percentages, and continuous variables as mean ± SD.

RESULTS

A total of 67 elderly patients were included, with a mean age of 72.7 ± 6.33 years; most were male (72%). The median duration of the EUS procedure was 19 (23) minutes. Most patients underwent biopsy for pancreatic lesions (40.3%), followed by mediastinal (16.4%) and gallbladder/common bile duct lesions (13.4%). In 31.4% cases, the specimen was obtained with 2 needle passes, while 41.4% required 1 pass and 22.9% required 3 passes. Multi-targeted biopsies using a single pass were performed in 7.5% cases. A Franseen-design needle was used in all cases, with 22G utilized in 92.5% and 25G in 7.5%. Diagnostic adequacy was 100%, with no procedure-related complications. Histopathology revealed pancreatic cancer (34.3%), benign lesions (28.4%), and metastatic renal carcinoma (6%).

CONCLUSION

EUS-FNB is an effective minimally invasive diagnostic tool in elderly, demonstrating high diagnostic adequacy without complications. Future studies are warranted to further validate its safety and effectiveness in this population.

Keywords: Endosonography; Endoscopic ultrasound-guided fine needle biopsy; Aged; Geriatric population; Malignancy; Diagnostic yield; Minimally invasive diagnosis; Procedural safety and low- and middle-income countries

Core Tip: This retrospective study evaluates the diagnostic yield and safety of endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) in elderly patients with gastrointestinal lesions at a tertiary care centre in Pakistan. Using the Franseen needle and macroscopic on-site evaluation, EUS-FNB achieved 100% technical success and diagnostic yield with no reported procedural related complications. The median of two needle passes along with shorter average procedure time, making it highly feasible for the geriatric population. These findings support EUS-FNB as a safe, efficient, and minimally invasive alternative for tissue diagnosis in elderly patients, even in resource-constrained settings.