Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society · 2025
Traction-assisted endoscopic ultrasound-guided fine-needle biopsy using the clip-with-thread method for small gastric subepithelial lesions: Randomized controlled trial (with video).
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Minoda Yosuke, Suzuki Yusuke, Ogino Haruei, Nagatomo Shuzaburo, Bai Xiaopeng, Esaki Mitsuru, Wada Masafumi, Tanaka Yoshimasa, Hata Yoshitaka, Fujimori Nao, Umekita Shinya, Tsurumaru Daisuke, Ota Mitsuhiko, Oki Eiji, Ihara Eikichi, Ogawa Yoshihiro
Аннотация
OBJECTIVES: Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) is the gold standard for diagnosing gastric subepithelial lesions (SELs), but diagnosing lesions smaller than 20 mm remains challenging. We developed traction-assisted EUS-FNB (TA-EUS-FNB) using the clip-with-thread method to enhance diagnostic accuracy by stabilizing the lesion and providing counter-traction for easier needle access. This study evaluates the effectiveness of TA-EUS-FNB in diagnosing small gastric SELs.
METHODS: In this prospective, randomized, controlled cross-over trial (August 2019-November 2022), 30 patients with gastric SELs <20 mm were randomized to undergo TA-EUS-FNB or conventional EUS-FNB. Each patient underwent four punctures, two per method. The primary end-point was the adequate tissue sampling rate for both techniques. Secondary end-points included diagnostic yield and performance (sensitivity and specificity) in distinguishing gastrointestinal stromal tumors (GISTs) from non-GISTs.
RESULTS: The mean tumor size was 15.0 mm, with diagnoses comprising GISTs (n = 15, 50%), leiomyomas (n = 8, 26.7%), schwannomas (n = 2, 6.7%), aberrant pancreas (n = 3, 10%), and inflammation (n = 2, 6.7%). TA-EUS-FNB demonstrated a significantly higher adequate-tissue sampling rate (90% vs. 66.7%, P = 0.035) and diagnostic yield (86.7% vs. 63.3%, P = 0.037) than conventional EUS-FNB. Sensitivity (86.7%, 95% confidence interval [CI] 62.1-96.3% vs. 66.7%, 95% CI 41.7-84.8%; P = 0.20) and specificity (100%, 95% CI 79.6-100% vs. 100%, 95% CI 79.6-100%) were comparable between the methods. No adverse events were observed in the study.
CONCLUSION: TA-EUS-FNB demonstrated superior tissue sampling rates and diagnostic yield for SELs <20 mm compared to conventional EUS-FNB, making it a viable option. Controlling lesion mobility is essential for successful EUS-FNB in small SELs.
METHODS: In this prospective, randomized, controlled cross-over trial (August 2019-November 2022), 30 patients with gastric SELs <20 mm were randomized to undergo TA-EUS-FNB or conventional EUS-FNB. Each patient underwent four punctures, two per method. The primary end-point was the adequate tissue sampling rate for both techniques. Secondary end-points included diagnostic yield and performance (sensitivity and specificity) in distinguishing gastrointestinal stromal tumors (GISTs) from non-GISTs.
RESULTS: The mean tumor size was 15.0 mm, with diagnoses comprising GISTs (n = 15, 50%), leiomyomas (n = 8, 26.7%), schwannomas (n = 2, 6.7%), aberrant pancreas (n = 3, 10%), and inflammation (n = 2, 6.7%). TA-EUS-FNB demonstrated a significantly higher adequate-tissue sampling rate (90% vs. 66.7%, P = 0.035) and diagnostic yield (86.7% vs. 63.3%, P = 0.037) than conventional EUS-FNB. Sensitivity (86.7%, 95% confidence interval [CI] 62.1-96.3% vs. 66.7%, 95% CI 41.7-84.8%; P = 0.20) and specificity (100%, 95% CI 79.6-100% vs. 100%, 95% CI 79.6-100%) were comparable between the methods. No adverse events were observed in the study.
CONCLUSION: TA-EUS-FNB demonstrated superior tissue sampling rates and diagnostic yield for SELs <20 mm compared to conventional EUS-FNB, making it a viable option. Controlling lesion mobility is essential for successful EUS-FNB in small SELs.