Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline - March 2017

Presented by

Synopsis

Recommendations
For routine EUS-guided sampling of solid masses and lymph nodes (LNs) ESGE recommends 25G or 22G needles (high quality evidence, strong recommendation); fine needle aspiration (FNA) and fine needle biopsy (FNB) needles are equally recommended (high quality evidence, strong recommendation).

When the primary aim of sampling is to obtain a core tissue specimen, ESGE suggests using 19G FNA or FNB needles or 22G FNB needles (low quality evidence, weak recommendation).

ESGE recommends using 10-mL syringe suction for EUSguided sampling of solid masses and LNs with 25G or 22G FNA needles (high quality evidence, strong recommendation) and other types of needles (low quality evidence, weak recommendation).

ESGE suggests neutralizing residual negative pressure in the needle before withdrawing the needle from the target lesion (moderate quality evidence, weak recommendation).

ESGE does not recommend for or against using the needle stylet for EUS-guided sampling of solid masses and LNs with FNA needles (high quality evidence, strong recommendation) and suggests using the needle stylet for EUSguided sampling with FNB needles (low quality evidence, weak recommendation).

ESGE suggests fanning the needle throughout the lesion when sampling solid masses and LNs (moderate quality evidence, weak recommendation).

ESGE equally recommends EUS-guided sampling with or without on-site cytologic evaluation (moderate quality evidence, strong recommendation). When on-site cytologic evaluation is unavailable, ESGE suggests performance of three to four needle passes with an FNA needle or two to three passes with an FNB needle (low quality evidence, weak recommendation).

For diagnostic sampling of pancreatic cystic lesions without a solid component, ESGE suggests emptying the cyst with a single pass of a 22G or 19G needle (low quality evidence, weak recommendation). For pancreatic cystic lesions with a solid component, ESGE suggests sampling of the solid component using the same technique as in the case of other solid lesions (low quality evidence, weak recommendation).

ESGE does not recommend antibiotic prophylaxis for EUSguided sampling of solid masses or LNs (low quality evidence, strong recommendation), and suggests antibiotic prophylaxis with fluoroquinolones or beta-lactam antibiotics for EUS-guided sampling of cystic lesions (low quality evidence, weak recommendation).

ESGE suggests that evaluation of tissue obtained by EUSguided sampling should include histologic preparations (e. g., cell blocks and/or formalin-fixed and paraffinembedded tissue fragments) and should not be limited to smear cytology (low quality evidence, weak recommendation).

Keywords: Endoscopic ultrasound-guided fine needle aspiration; EUS-guided sampling; fine needle biopsy; interventional ultrasonography; pancreatic neoplasms; carcinoma, pancreatic ductal; image-guided biopsy; solid masses; lymphadenopathy; cytology; histology

Available Languages

English

Source File

Publishing organization(s):

ESGE European Society of Gastrointestinal Endoscopy

Scientific area:

Endoscopy
 


This item can be cited as: Endoscopy 2017; 49: 989–1006; PMID 28898917

Categorisation:

  • Document Type
    • Standard Protocol
  • Format
    • Standards and Guidelines
  • Language
    • English
  • UEG Member Society
    • European Society of Gastrointestinal Endoscopy (ESGE)
  • UEG Week Pathway
    • Endoscopy
  • Year
    • 2017