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Comparison of Specimen Quality among the Standard Suction, Slow-Pull, and Wet Suction Techniques for EUS-FNB: A Monocentric, Prospective, Randomized Controlled Trial
Poster Abstract

Aims

Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is the gold standard for tissue acquisition of solid and solid-cystic lesions of the pancreas and gastrointestinal tract. Several aspiration techniques have been proposed to optimise histological yield, including the standard suction technique (SST), slow-pull technique (SPT), and wet suction technique (WEST).This study aimed to compare specimen quality and diagnostic performance of these three approaches using a 22-gauge FNB needle.

Methods

This monocentric, prospective, randomised controlled trial was conducted at the Mohammed VI University Hospital (Marrakech) from January 2023 to October 2025.Patients with solid or solid-cystic pancreatic or subepithelial lesions referred for EUS-FNB were consecutively enrolled.Each lesion was sampled using the three techniques (SST, SPT, WEST) in random order during the same procedure, with two passes per technique.Specimens were evaluated by two blinded pathologists for blood contamination, tissue integrity, cellularity, core length, and diagnostic adequacy, each scored 0–2.Primary endpoint: overall specimen quality score (sum of individual items).Secondary endpoints: diagnostic yield, core tissue length, and adverse events. Statistical analysis used SPSS 26.0 with p < 0.05 considered significant.

Results

A total of 126 patients (mean age 59 ± 12 years; 54 % men) were included.Lesion sites: pancreas (68 %), lymph nodes (19 %), subepithelial or mediastinal (13 %).Overall quality score: WEST = 8.7 ± 2.1, SPT = 8.1 ± 2.0, SST = 7.4 ± 2.3 (p = 0.012 WEST vs SST; p = 0.09 WEST vs SPT).

  • Tissue integrity: WEST 1.78 ± 0.43 > SPT 1.61 ± 0.48 > SST 1.42 ± 0.52 (p = 0.004).

  • Cellularity: WEST 1.66 ± 0.51 vs SPT 1.52 ± 0.54 vs SST 1.39 ± 0.59 (p = 0.02).

  • Core length: longest with WEST (18.3 ± 6.7 mm) vs SPT 15.9 ± 5.9 mm and SST 13.8 ± 6.1 mm (p = 0.01).

  • Blood contamination: lowest with SPT (1.31 ± 0.61) compared with WEST (1.46 ± 0.58) and SST (1.58 ± 0.63) (p= 0.03).Diagnostic adequacy: 95.2 % (WEST) vs 90.4 % (SPT) vs 86.5 % (SST);Diagnostic accuracy: 78.6 % (WEST) vs 70.6 % (SPT) vs 66.7 % (SST) (p = 0.02).No major adverse event was observed; two patients (1.6 %) developed mild self-limited bleeding.

Conclusions

In this two-year prospective trial, the wet suction technique (WEST) provided the best tissue integrity, cellularity, and core length, achieving the highest diagnostic yield without increasing complications.The slow-pull technique offered superior blood control, whereas the standard suction method yielded the poorest histologic quality.WEST should be considered the optimal approach for EUS-FNB of solid and mixed lesions when high-quality core biopsy is required.