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.