Comparison between the different suction techniques for eus-guided tissue acquisition in pancreatic diseases and other gastrointestinal lesions: a systematic review and meta-analysis of randomized controlled trials

Edson Guzmán-Calderón; Carlos Díaz-Arocutipa; Augusto Vera; José Ramón Aparicio

doi:10.47892/rgp.2026.463.2246

Authors

Edson Guzmán-Calderón Gastroenterology Unit, Angloamericana Clinic, Lima, Peru; Gastroenterology Unit, Angloamericana Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru. https://orcid.org/0000-0002-1673-3669
Carlos Díaz-Arocutipa Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Perú. https://orcid.org/0000-0002-5101-2832
Augusto Vera Gastroenterology Unit, Angloamericana Ricardo Palma Clinic, Lima, Peru. https://orcid.org/0000-0003-3036-3745
José Ramón Aparicio Gastroenterology Unit, Angloamericana Hospital General Universitario de Alicante, Alicante, Spain. https://orcid.org/0000-0003-2245-4006

DOI:

https://doi.org/10.47892/rgp.2026.463.2246

Keywords:

Endoscopic Ultrasound-Guided Fine Needle Aspiration, Biopsy, Needle, Suction, Pancreatic Diseases, Gastrointestinal Diseases, Specimen Handling

Abstract

Objectives: Endoscopic ultrasound–guided fine-needle aspiration/biopsy (EUS-FNA/B) is pivotal for diagnosing solid pancreatic lesions and other gastrointestinal (GI) masses. Multiple suction strategies are used to optimize tissue acquisition. Currently, their comparative performance remains uncertain. Materials and methods: We searched PubMed, Medline, Cochrane, and Ovid through July 2025 for English-language. RCTs comparing four suction methods during EUS-FNA/B of solid pancreatic or other GI lesions. Primary outcomes were specimen tissue adequacy and diagnostic accuracy. Results: Twenty-two RCTs encompassing 2,922 patients were included; pancreas was the sampled organ in 81% of cases, with the remainder primarily lymph nodes. Across 20 RCTs reporting adequacy, WS was associated with lower specimen adequacy than no suction (RR 0.88, 95% CI 0.77-0.99). WS likewise yielded lower diagnostic accuracy than no suction (RR 0.89, 95% CI 0.82-0.97). In head-tohead comparisons versus DS, differences among DS, SSP/capillarity, no suction, and WS were generally nonsignificant. Ranking analyses favoured no suction as the top performer and consistently placed WS lowest for both adequacy (p=0.92 vs 0.06, respectively) and accuracy (p=0.96 vs 0.04, respectively). In the needle-stratified analysis, results were concordant: with 22-G devices, WS showed lower adequacy (RR 0.86, 95% CI 0.74-0.99) and lower accuracy (RR 0.86, 95% CI 0.77-0.95) than with no suction. Conclusions: This meta-analysis suggests that wet suction may be associated with lower diagnostic yield and reduced tissue adequacy compared to no suction, especially with 22G needles. However, outside of these comparisons, no consistent differences were observed among the other techniques. Future comparative studies with standardized methodology and stricter control of confounding factors are needed.

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