EUS guided tissue sampling - ESGE statement

The European Society of Gastrointestinal Endoscopy (ESGE) has issued updated statements and recommendations regarding endoscopic ultrasound (EUS)-guided tissue sampling, emphasizing advancements in needle technology, sampling techniques, and specimen handling to optimize diagnostic accuracy. The key points of the ESGE statement are outlined below:

### 1. **Needle Design and Selection**:

• **End-cutting Fine-Needle Biopsy (FNB) Needles**: ESGE recommends end-cutting FNB needles over reverse-bevel FNB or standard fine-needle aspiration (FNA) needles for sampling solid pancreatic lesions. This recommendation is based on evidence showing that end-cutting FNB needles provide superior tissue yield and histologic quality.
• **Fine-Needle Aspiration (FNA)**: FNA remains a valuable option when rapid on-site evaluation (ROSE) is available. ROSE allows real-time assessment of sample adequacy, ensuring diagnostic accuracy during the procedure.

### 2. **Subepithelial Lesions (SELs)**:

• For SELs measuring **≥20 mm**, ESGE considers both EUS-FNB and mucosal incision–assisted biopsy (MIAB) as equally effective sampling methods.
• For SELs measuring **<20 mm**, MIAB may be preferred when the operator has sufficient expertise. MIAB is advantageous for smaller lesions as it allows more precise tissue acquisition.

### 3. **Infection Prevention**:

• ESGE no longer recommends routine antibiotic prophylaxis before EUS-guided sampling of solid masses or during EUS-FNA of pancreatic cystic lesions. This change reflects evidence indicating a low risk of infection and the need to avoid unnecessary antibiotic use.

### 4. **Specimen Handling and Diagnostic Accuracy**:

• ESGE emphasizes the importance of precision-driven sampling strategies and efficient specimen handling to improve diagnostic outcomes. Proper handling of tissue samples is critical for achieving high histologic quality and accurate diagnoses.

### 5. **Advancements in EUS Technology**:

• The updated ESGE review highlights advancements in needle technology and sampling techniques, which have significantly improved the diagnostic yield and quality of EUS-guided tissue acquisition.

### Summary:

The ESGE statement underscores the importance of selecting the appropriate needle type, tailoring sampling techniques to the lesion type and size, and adopting evidence-based approaches to specimen handling. These updates are aimed at improving diagnostic outcomes and minimizing unnecessary interventions, such as routine antibiotic prophylaxis, in EUS-guided tissue sampling.