Factors associated with diagnostic accuracy, technical success and adverse events of endoscopic ultrasound‐guided fine‐needle biopsy: A systematic review and meta‐analysis

Abstract

Background and AimEndoscopic ultrasound‐guided fine‐needle biopsy (EUS‐FNB) is used to diagnose lesions within or adjacent to the digestive tract. However, there is no report on the overall diagnostic accuracy, technical success, and adverse events of FNB. The aims of this study were to conduct a systematic review and meta‐analysis to comprehensively assess the diagnostic accuracy, technical success, and adverse events of FNB.MethodsPubmed, Embase, and Cochrane Library databases were searched for relevant articles published in English from January 1998 to May 2019 (No. CRD42019141647). Primary outcomes were EUS‐FNB related diagnostic accuracy rate, technical success rate, and adverse event rate.ResultsA total of 51 articles including 5330 patients met our criteria. The overall EUS‐FNB related diagnostic accuracy rate, technical success rate, and adverse event rate was 90.82% [95% confidence interval (CI) 88.69–92.76%], 99.71% [95% CI 99.35–99.93%], and 0.59% [95% CI 0.29–1.0%], respectively. Biopsy with 22G needle could increase the diagnostic accuracy rate and technical success rate to 92.17% [95% CI 89.32–94.61%] and 99.88% [95% CI 99.64–99.99%], respectively, and decrease the adverse event to 0.37% [95% CI 0.08–0.87%]. Moreover, it showed that 22G needle was an independent factor associated with a higher diagnostic accuracy rate and technical success rate and a lower adverse event rate (P = 0.04, P < 0.001, and P = 0.04, respectively) by univariate and multivariate meta‐regression analyses.ConclusionEndoscopic ultrasound‐guided fine‐needle biopsy is a feasible and safe procedure for lesions within or adjacent to the digestive tract. Biopsy using 22G needle could increase the diagnostic accuracy rate and technical success rate and decrease adverse event rate during the FNB procedure.

Efficacy, Feasibility, and Safety of Endoscopic Ultrasound-guided Fine-needle Biopsy for the Diagnosis of Gastrointestinal Subepithelial Lesions

“…However, a previous meta-analysis discovered that 22 G needles were a predictor related to a higher diagnostic yield than 19, 20, and 25 G needles. 36 This discrepancy may be attributed to the targeted objects, as other studies included all the lesions around the digestive tract, while our study only included SELs. One of our included studies showed that 22 G needles and 25 G needles both had relatively high diagnostic yields (89% and 86%, respectively).…”

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

“…The incidence of haemorrhage following endoscopic ultrasound (EUS)-guided sampling has been analysed in several systematic reviews; the figure per thousand was 1.28 for EUS-guided with fine-needle aspiration (FNA) (51 studies, 10 941 patients), 123 5.81 for EUS-fine needle biopsy (FNB) (51 studies, 5330 patients) 124 and 6.63 for EUS-FNA of pancreatic cystic lesions (40 studies, 5124 patients). 125 Four studies reported on haemorrhage following EUS-guided sampling in patients prescribed antithrombotic agents.…”

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

“…The incidence of haemorrhage following EUS-guided sampling has been analysed in several systematic reviews; the figure per thousand was 1.28 for EUS-FNA (51 studies, 10,941 patients) 123 , 5.81 for EUS-fine needle biopsy (FNB) (51 studies, 5,330 patients) 124 and 6.63 for EUS-FNA of pancreatic cystic lesions (40 studies, 5,124 patients) 125 . Four studies reported on haemorrhage following EUS-guided sampling in patients prescribed antithrombotic agents 126 127 128 129 .…”