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Endoscopy
January 4th, 2019

Global prospective randomized controlled study shows EUS FNB needle out-performs FNA**


Erasmus University Medical Center in Rotterdam recently e-published Level 1b* data from the ‘ASPRO’ study—an international, 608-patient, prospective randomized multicentre trial—which was designed to establish superiority of endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) over fine needle biopsy (FNB), or vice versa.

The use of EUS FNB over FNA has seen a strong upward trend over the last several years since the introduction of the FNB needle design entering the marketplace. A number of studies have emerged investigating the diagnostic yield and accuracy of the procedure, but many have been retrospective, did not include the whole range of indications, and/or were performed in a single center, which hampered their generalizability**.

The ASPRO study specifically compares the diagnostic accuracy of EUS-guided tissue acquisition using a 20 gauge FNB device (Cook Medical EchoTip ProCore® needle) with the widely used 25 gauge FNA device (Cook Medical EchoTip® Ultra needle). The analysis concluded the 20 gauge FNB needle consistently outperformed the 25 gauge FNA needle in terms of histological yield and diagnostic accuracy, in pancreatic as well as non-pancreatic lesions, independent of the number of passes performed**.

This diagnostic benefit of the FNB needle was consistent amongst the 13 participating centers, despite inter-centre practices or the presence of rapid on-site evaluation (ROSE), which supports the general applicability of these findings. Results also showed no differences in adverse events between the 20 gauge and 25 gauge needle sizes.

The full clinical study has been e-published ahead of print and is available online with a Gastrointestinal Endoscopy subscription. Open access to the abstract is available online via the GIE website. https://doi.org/10.1016/j.gie.2018.10.026

References:
* Oxford Centre for Evidence-based Medicine – Levels of Evidence:
https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/

** van Riet PA, Larghi A, Attili F, Rindi G, Nguyen NQ, Ruszkiewicz A, Kitano M, Chikugo T, Aslanian H, Farrell J, Robert M, Adeniran A, van der Merwe S, Roskams T, Chang K, Lin F, Lee JG, Arcidiacono PG, Petrone M, Doglioni C, Iglesias-Garcia J, Abdulkader I, Giovannini M, Bories E, Poizat F, Santo E, Scapa E, Marmor S, Bucobo JC, Buscaglia JM, Heimann A, Wu M, Baldaque- Silva F, Moro CF, Erler NS, Biermann K, Poley JW, Cahen DL, Bruno MJ. A multicenter randomized trial comparing a 25-gauge EUS fine-needle aspiration device with a 20-gauge EUS fine-needle biopsy device. Gastrointestinal Endoscopy, e-published Oct 2018.

This study was supported by a restricted grant from Cook Medical. Cook Medical had no influence over study design or final results reported.