"Vanishing needle tract" in endoscopic ultrasound-guided tissue acquisition: definition, incidence, and risk factors in a large single-center cohort

Yasuhiro Komori; Susumu Hijioka; Shin Yagi; Yoshikuni Nagashio; Shota Harai; Daiki Yamashige; Kazunori Onuma; Keita Fujisaki; Daiki Agarie; Kohei Okamoto; Soma Fukuda; Masaru Kuwada; Joshua Josef Torres; Keijiro Ueda; Nao Fujimori; Yutaka Saito; Yoshihiro Ogawa; Takuji Okusaka

doi:10.1016/j.gie.2026.05.009

"Vanishing needle tract" in endoscopic ultrasound-guided tissue acquisition: definition, incidence, and risk factors in a large single-center cohort

Gastrointest Endosc. 2026 May 20:S0016-5107(26)06744-1. doi: 10.1016/j.gie.2026.05.009. Online ahead of print.

Authors

Yasuhiro Komori¹, Susumu Hijioka², Shin Yagi¹, Yoshikuni Nagashio¹, Shota Harai¹, Daiki Yamashige¹, Kazunori Onuma¹, Keita Fujisaki¹, Daiki Agarie¹, Kohei Okamoto¹, Soma Fukuda¹, Masaru Kuwada¹, Joshua Josef Torres¹, Keijiro Ueda³, Nao Fujimori³, Yutaka Saito⁴, Yoshihiro Ogawa³, Takuji Okusaka¹

Affiliations

¹ Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan.
² Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan. Electronic address: shijioka@ncc.go.jp.
³ Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
⁴ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.

PMID: 42155685
DOI: 10.1016/j.gie.2026.05.009

Abstract

Background and aims: In EUS-guided tissue acquisition (EUS-TA), the needle tip may occasionally become invisible on the EUS image during advancement. We named this phenomenon "vanishing needle tract" (VNT) and investigated its incidence, associated factors, and directional characteristics.

Methods: This single-center retrospective study included cases of EUS-TA performed between September 2021 and December 2024. The occurrence and direction of VNT were recorded in the database by the performing endoscopist immediately after each procedure. The direction of VNT was defined by the needle disappearance and classified as clockwise VNT or counterclockwise VNT.

Results: Of the 2094 lesions for which EUS-TA was performed during the study period, 1630 were analyzed. The pancreas was the most common target (60.2%), with a median lesion size of 20 mm. The puncture routes included the stomach (61.8%), duodenal bulb (17.0%), and the second portion of the duodenum (21.2%). The median number of punctures was 2 (range, 1-7). VNT occurred in 26.6% of cases, of which 75.8% were clockwise VNT. Significant risk factors for VNT included puncture via the duodenal bulb (P < .001), higher number of punctures (P < .001), and use of Franseen needles (P = .012).

Conclusions: VNT is a relatively common phenomenon occurring predominantly in the clockwise direction. It is more likely to occur in cases of limited maneuverability, as in the duodenal bulb, or multipoint needle contact, as with a Franseen needle. By defining this novel concept of VNT, our study contributes to the standardization of EUS-TA and future improvements in device design.