Slow Pull Versus Suction in Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Pancreatic Solid Masses

Abstract

The slow-pull technique was associated with less contamination with blood and can potentially increase the diagnostic yield compared with the suction technique in EUS-FNA of pancreatic solid masses, especially with a 25-gauge FNA needle.

“Wet suction technique (WEST)”: a novel way to enhance the quality of EUS-FNA aspirate. Results of a prospective, single-blind, randomized, controlled trial using a 22-gauge needle for EUS-FNA of solid lesions

“…There was no difference in the quality of aspirates between FNA with suction and the slow-pull technique when a 22-gauge needle was used. 12 As suggested by the cited studies, the use of suction may improve cellularity and the quality of aspirate, but at the cost of increased bloodiness and contamination. The increased bloodiness and contamination may lead to reduction in diagnostic accuracy, thereby negating any benefits of higher cellularity.…”

Accuracy and inter-observer agreement of the Procore™ 25 gauge needle for endoscopic ultrasound-guided tissue core biopsy

“…Fourth, the pathologists selected in our study were dedicated to gastrointestinal diseases, therefore that we cannot predict if the high degree of reproducibility among them observed in our study can also be found among non-dedicated pathologists. Fifth, we did not utilize the so called "slow pull technique" that seems to gather better samples when a 25G needle is used [35]. However, this data was not yet available and the current evidence is still limited.…”

Eliminating the Residual Negative Pressure in the Endoscopic Ultrasound Aspirating Needle Enhances Cytology Yield of Pancreas Masses

“…8,17,18 Bang and colleagues reported high diagnostic yield using FNA needle without suction while others have shown that the slow-pull or “capillary suction” technique by slowly withdrawing the needle stylet while obtaining samples resulted in a higher yield. 19,20 Lee at al performed a randomized controlled trial on 81 patients with solid pancreas masses comparing cytologic features as well as diagnostic yield in samples obtained with and without suction. 9 Samples obtained with the use of 10 mL suction had higher diagnostic yield (72.8% vs. 58.6%, p = 0.001), cellularity (OR: 2.12, 95% CI: 1.3–3.3, p < 0.001), and also greater accuracy (82.4% vs. 72.1%, p < 0.001) compared to samples obtained without suction.…”