A new micro‐forceps for endoscopic ultrasound‐guided through‐the‐needle biopsy in the diagnosis of pancreatic cystic lesions: Single center experience

Abstract

Background and Aim Endoscopic ultrasound (EUS)‐guided through‐the‐needle biopsy (TTNB) has improved the diagnostic algorithm of pancreatic cystic neoplasms (PCNs). Recently, a new through‐the‐needle micro‐forceps device (Micro Bite, MTW Endoskopie Manufakture) has been introduced. The primary aim was to assess the safety and technical success of this new type of micro‐forceps. The secondary aim was to evaluate the diagnostic role of EUS‐TTNB. Methods Retrospective study of consecutive patients receiving EUS‐TTNB for the diagnosis of PCNs. Two micro‐forceps were used: Moray Micro‐forceps and Micro‐Bite. Cystic fluid was collected for cytological analysis. Categorical variables were analyzed by Fisher's exact test, and continuous variables were analyzed by Student's t‐test. P < 0.05 was considered significant. Results Forty‐nine patients enrolled in the study (24% male; mean age 63 ± 14 years). TTNB was successfully performed in all patients. A diagnostic sample was obtained in 67.3% PCNs with TTNB compared with 36.7% with cyst fluid cytology (P 0.01). Adverse events rate was 10.2% and occurred in older patients (76.6 ± 5.4 vs 61.3 ± 13.7 P = 0.02). The 51% underwent EUS‐TTNB with Micro Bite. A diagnostic sample was obtained in 52% PCNs with Micro Bite compared with 24% obtained with cyst fluid cytology (P = 0.07). Comparing the two devices, the rate of diagnostic sample obtained with the micro‐forceps Moray was higher than that obtained with the Micro Bite (20/24 [83.3%] vs 13/25 [52%] P 0.03). Conclusions EUS‐TTNB increases the diagnostic yield of PCNs. The new Micro‐Bite could represent a valid alternative to the currently used Moray Micro‐forceps, but its diagnostic rate is still suboptimal and further studies are needed.

EUS-guided through the needle microbiopsy: a useful adjunct in the investigation of pancreatic cystic lesions

“…AE rates for FNA have been reported in the region of 2% 23 33 34. Although the 9% AE rate in this cohort is comparable to the 5%–16.7% previously reported, EUS-TTNB confers an added risk in comparison to FNA alone 9 31 35. Although the patients in this cohort had moderate pancreatitis with no long-term sequelae, a 3% risk of severe pancreatitis has been reported with one fatal case 36.…”

Rare Pancreatic/Peripancreatic Cystic Lesions Can Be Accurately Characterized by EUS with Through-the-Needle Biopsy—A Unique Pictorial Essay with Clinical and Histopathological Correlations

“…EUS-TTNB is one of the most recent and promising techniques for the definition of PCLs, with excellent technical success (98.5%, CI 97.3-99.6%) and high accuracy (86.7%, CI 80.1-93.4) according to a recent metanalysis [15]. Several studies have compared TTNB to standard EUS-FNA, with conventional fluid analysis demonstrating the clear superiority of TTNB in risk stratification and its ability to provide a specific diagnosis [8,9,[11][12][13][38][39][40][41][42][43][44][45][46][47][48]. Moreover, a study demonstrated that EUS-TTNB specimens are suitable for molecular analyses [49].…”

“…The procedure, called through-the-needle biopsy (TTNB), is technically feasible and relatively safe [7]. Both retrospective and prospective studies [8][9][10][11][12][13][14] have reported a histological yield ranging from 75% to 99.2% [15], and a specific cyst histotype has been recognized in 74% of cases [14]. Moreover, the interobserver agreement between expert pathologists has been demonstrated to be substantial [16].…”

Pancreatic lymphoepithelial cyst with concurrent HIV infection: A case report and review of the literature

“… 8 Various meta-analysis studies have revealed overall high specificity and low sensitivity of EUS-FNA-based cytology in differentiating mucinous from non-mucinous pancreatic cysts, 9 with a variable sensitivity of 35%–63% and specificity of 83%–99%. 10 – 12 One of the recent innovations to improve diagnostic accuracy of PCL is the use of endoscopic ultrasonography-guided through-the-needle biopsy (EUS-TTNB). By inserting a micro-forceps device through a 19-gauge needle, this technique enhances tissue sampling of PCL and thus leads to a more definitive diagnosis and decrease in interobserver variability.…”