The Heparinized Wet-Suction Technique Enhances Aspiration Quality and Quantity of EUS-FNA for Solid Pancreatic Lesions: A Retrospective Study

Abstract

Background The optimal suction method for performing endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) on solid pancreatic lesions (SPLs) remains unclear. This study aims to compare the heparinized wet-suction technique (HWST) with the conventional dry-suction technique(DST) for EUS-FNA in SPLs. Methods We conducted a retrospective study on EUS-FNA procedures at a single medical center in China. A total of 105 patients were enrolled who received 3 passes of EUS-FNA with 19-G needles. Sample quantity (including specimen adequacy, maximum intact specimen (MIS) length, and macroscopic visible core (MVC) length), sample quality (including cytology and histology blood contamination), diagnostic accuracy, and adverse events were compared between DST and HWST. Results From January 2021 to April 2024, a total of 105 patients (DST group: n = 50; HWST group: n = 55) were analyzed in this study. The specimen adequacy score was significantly higher with HWST compared to DST in the first pass (P = 0.006), the second pass (P = 0.032), and the combined total of three passes (P = 0.010). HWST produced longer MIS and MVC lengths than DST in the first pass (MIS: P = 0.001; MVC: P < 0.001), the second pass (MIS: P = 0.001; MVC: P = 0.022), and the combined total of three passes (MIS: P = 0.001; MVC: P < 0.001). Compared with DST, HWST yielded a lower blood contamination score in the first pass (cytology: P = 0.002; histology: P = 0.005), the second pass (histology: P = 0.035), and the combined total of three passes (cytology: P = 0.035; histology: P = 0.036). In terms of diagnostic yield, HWST demonstrated a significantly superior histological accuracy in the first pass compared with DST (P = 0.036). Conclusions EUS-FNA with HWST led to significantly higher specimen quantity and quality, improved first-pass histological diagnostic accuracy, and comparable safety to DST. HWST may have a wide range of applications in clinical practice.