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Heparin Wet Suction Versus Conventional Suction in Endoscopic Ultrasound-Guided Fine-Needle Biopsy for Solid
Hyung Ku Chon1, Dong Kee Jang2, Woo Hyun Paik3
1Division of Biliopancreas, Department of Internal Medicine, Wonkwang University College of Medicine, Institute of Wonkwang Medical Science, Iksan, Republic of Korea.
Background And Aim:
The heparin wet suction technique (HWST) may improve tissue quality in endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) by preventing blood clot formation within the needle. We compared the diagnostic performance and safety of HWST with the conventional suction technique (CST), using a novel 22-gauge FNB needle in patients with solid pancreatic masses.
Methods:
In this multicenter, single-blinded, randomized crossover trial, patients with solid pancreatic masses (≥ 1 cm) were randomized 1:1 to HWST-first or CST-first. Each patient underwent one pass with each technique using the novel 22-gauge needle. The primary outcome was diagnostic yield; secondary outcomes included technical success, adverse events, and adequacy for immunohistochemistry (IHC).
Results:
Of 174 randomized patients, 170 received both interventions and were analyzed; baseline characteristics were comparable. The diagnostic yield was 82.9% (95% confidence interval [CI], 76.6-87.9) with HWST and 83.5% (95% CI, 77.2-88.4) with CST. The paired difference was -0.6 percentage points (95% CI, -6.7 to 5.5; exact McNemar p = 1.000). The combined diagnostic yield after sequential sampling was 91.2% (95% CI, 86.0-94.6). Technical success was 100% with both techniques, and IHC adequacy was similar (HWST: 80.6% vs. CST: 78.8%). One self-limiting bleeding event occurred during CST.
Conclusions:
HWST showed diagnostic yield, technical success, and safety comparable to CST. Both techniques are highly effective for EUS-FNB of solid pancreatic masses. Sequential sampling may improve overall diagnostic yield, although this finding should be interpreted cautiously and requires further validation.