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Practice Guideline
. 2017 Oct;49(10):989-1006.
doi: 10.1055/s-0043-119219. Epub 2017 Sep 12.

Technical Aspects of Endoscopic Ultrasound (EUS)-guided Sampling in Gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline - March 2017

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Practice Guideline

Technical Aspects of Endoscopic Ultrasound (EUS)-guided Sampling in Gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline - March 2017

Marcin Polkowski et al. Endoscopy. .
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Abstract

For routine EUS-guided sampling of solid masses and lymph nodes (LNs) ESGE recommends 25G or 22G needles (high quality evidence, strong recommendation); fine needle aspiration (FNA) and fine needle biopsy (FNB) needles are equally recommended (high quality evidence, strong recommendation).When the primary aim of sampling is to obtain a core tissue specimen, ESGE suggests using 19G FNA or FNB needles or 22G FNB needles (low quality evidence, weak recommendation).ESGE recommends using 10-mL syringe suction for EUS-guided sampling of solid masses and LNs with 25G or 22G FNA needles (high quality evidence, strong recommendation) and other types of needles (low quality evidence, weak recommendation). ESGE suggests neutralizing residual negative pressure in the needle before withdrawing the needle from the target lesion (moderate quality evidence, weak recommendation).ESGE does not recommend for or against using the needle stylet for EUS-guided sampling of solid masses and LNs with FNA needles (high quality evidence, strong recommendation) and suggests using the needle stylet for EUS-guided sampling with FNB needles (low quality evidence, weak recommendation).ESGE suggests fanning the needle throughout the lesion when sampling solid masses and LNs (moderate quality evidence, weak recommendation).ESGE equally recommends EUS-guided sampling with or without on-site cytologic evaluation (moderate quality evidence, strong recommendation). When on-site cytologic evaluation is unavailable, ESGE suggests performance of three to four needle passes with an FNA needle or two to three passes with an FNB needle (low quality evidence, weak recommendation).For diagnostic sampling of pancreatic cystic lesions without a solid component, ESGE suggests emptying the cyst with a single pass of a 22G or 19G needle (low quality evidence, weak recommendation). For pancreatic cystic lesions with a solid component, ESGE suggests sampling of the solid component using the same technique as in the case of other solid lesions (low quality evidence, weak recommendation).ESGE does not recommend antibiotic prophylaxis for EUS-guided sampling of solid masses or LNs (low quality evidence, strong recommendation), and suggests antibiotic prophylaxis with fluoroquinolones or beta-lactam antibiotics for EUS-guided sampling of cystic lesions (low quality evidence, weak recommendation). ESGE suggests that evaluation of tissue obtained by EUS-guided sampling should include histologic preparations (e. g., cell blocks and/or formalin-fixed and paraffin-embedded tissue fragments) and should not be limited to smear cytology (low quality evidence, weak recommendation).

Conflict of interest statement

Competing interests: M. Barthet has provided consultancy and research support to Boston Scientific (from September 2015). S. Carrara has provided a paid lecture/course for Boston Scientific and for Olympus (2016). P. Deprez is providing paid consultancy to Boston Scientific and to Cook (January 2016 to December 2017, for both); his department is receiving sponsorship from Boston Scientific, Olympus, and Cook (January 2016 to December 2017, for all). J. Iglesias-Garcia has been a speaker and provided teaching activities for Boston Scientific (from 2016). B. Napoleon has received fees from Boston Scientific for educational workshops (2014 to present), and fees from Olympus for organisation of EUS 2016; his department has received support from Olympus for the organization of a meeting on contrast EUS (2015). J.E. van Hooft’s department is currently receiving research grants from Cook Medical, Boston Scientific, and Olympus; since 2015 she has been a member of EUS platform, a national network of professionals. G.P. Aithal, P.G. Arcidiacono, P. Bastos, J.-M. Dumonceau, P. Eisendrath, G. Fernández-Esparrach, A. Fornelli, A. Gines, C. Hassan, C. Jenssen, P. Kaye, A. Larghi, M. Polkowski, and A. Seicean have no competing interests.

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