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Related Experiment Video

Updated: Jun 25, 2026

Using the Endoscope for Endobronchial Ultrasound in the Esophagus

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Experimental endoscopy: objective evaluation of EUS needles.

Takao Itoi¹, Fumihide Itokawa, Toshio Kurihara

¹Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan. itoi@tokyo-med.ac.jp

Gastrointestinal Endoscopy

|February 24, 2009

Summary

Smaller EUS-guided needles (22-gauge and 25-gauge aspiration) are better for difficult insertions. Larger needles (19-gauge) face significant resistance, especially with endoscope angulation, impacting adequate sample acquisition.

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Area of Science:

Gastroenterology
Endoscopic Ultrasound (EUS)
Medical Device Engineering

Background:

Adequate sample acquisition during EUS-guided FNA is crucial for diagnosis.
Needle size, characteristics, and insertion conditions influence sample quality.
Endosonographers face challenges with needle advancement resistance.

Purpose of the Study:

To compare the performance of 19-gauge Tru-cut, 19-gauge aspiration, 22-gauge aspiration, and 25-gauge aspiration EUS needles.
To evaluate needle-insertion resistance under various simulated clinical conditions.
To provide standardized, reproducible data on EUS needle performance.

Main Methods:

Bench simulation using diagnostic and therapeutic EUS scopes.
Testing needle advancement resistance under straight and angulated endoscope positions.
Evaluating resistance with endoscopic tip angulation and elevator use.
Quantifying resistance in Newtons (N) and assessing qualitative levels (0-5).

Main Results:

25-gauge and 22-gauge needles showed low resistance (<2 N and <3 N, respectively).
19-gauge needles (aspiration/Tru-cut) exhibited high resistance (>8 N to >20 N) with angulation.
Significant resistance increases were observed with upward endoscope angulation and elevator use in 19-gauge needles.

Conclusions:

22-gauge and 25-gauge EUS-guided FNA needles are recommended for use when tight angulation is required.
Clinical validity of these findings requires further investigation.
Needle selection should consider angulation requirements for optimal sample acquisition.