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DIAGNOSTIC YIELD OF ENDOSCOPIC AND EUS-GUIDED BIOPSY TECHNIQUES IN SUBEPITHELIAL LESIONS OF THE UPPER GASTRO-INTESTINAL TRACT: A SYSTEMATIC REVIEW AND META-ANALYSIS

Cynthia Verloop 1, Jacqueline Goos 2, Marco J. Bruno 3, Rutger Quispel 4, Lydi van Driel 5, lieke Brouwer-Hol 1

Affiliations

1 Maasstad Hospital Rotterdam, Rotterdam, Netherlands

2 IJsselland hospital, Capelle aan den IJssel, Netherlands

3 University Medical Center Rotterdam, Rotterdam, Netherlands

4 Reinier de Graaf Gasthuis, Delft, Netherlands

5 Erasmus Medical Center, Schiedam, Netherlands

Summary

AI Generated

A systematic review of 94 studies comparing biopsy techniques for upper gastrointestinal subepithelial lesions found MIAB and EUS-FNB achieved the highest diagnostic yields with comparable complication rates.

MIAB achieved the highest pooled diagnostic yield at 88.2% (95% CI 84.7-91.1%), followed by EUS-FNB at 84.2% (95% CI 80.7-87.2%), EUS-FNA at 74.6% (95% CI 69.9-78.7%), and endoscopic biopsy at 40.6% (95% CI 30.8-51.2%).
Procedure-related complications graded Clavien-Dindo 2 or higher ranged from 1.9-6.7% for MIAB, 1.2-7.7% for EUS-FNB, 1.0-4.5% for EUS-FNA, and 2.8-3.9% for endoscopic biopsies.
The review included 94 original papers comprising 8 studies on endoscopic biopsy, 55 on FNA, 33 on FNB, and 26 on MIAB, with notable heterogeneity observed across studies.
The authors conclude that MIAB and EUS-FNB appear most effective for achieving high diagnostic yield with similar adverse event rates in upper gastrointestinal subepithelial lesions.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Obtaining adequate tissue samples in subepithelial lesions (SELs) remains challenging. Several biopsy techniques are available, but a systematic review including all available techniques to obtain a histological diagnosis of SEL is lacking. The aim of this study is to evaluate the diagnostic yield and complication rates of endoscopic biopsies, EUS-FNA, EUS-FNB and MIAB for SELs in the upper gastro-intestinal tract.

Aims & Methods

A search strategy in multiple databases was performed. The primary outcome was diagnostic yield, defined as the percentage of procedures where histology was obtained and resulted in a definitive histopathological diagnosis. Secondary outcome measures included reported procedure-related adverse events which were classified according to the Clavien-Dindo classification.

Results

A total of 94 original papers were included. Studies were classified per endoscopic technique to obtain histopathology. This resulted in 8 included studies for endoscopic biopsy methods, 55 studies for FNA, 33 studies for FNB and 26 studies for MIAB. Pooled rates for diagnostic yield were 40.6% (95% CI 30.8-51.2%) for endoscopic biopsy, 74.6% (95% CI, 69.9-78.7%) for EUS-FNA, 84.2% (95% CI 80.7-87.2%) for EUS-FNB, 88.2% (95% CI 84.7-91.1%) for MIAB. Notable heterogeneity was seen. Reported procedure-related complications graded Clavien-Dindo 2 or more were 2.8-3.9% for endoscopic biopsies, 1.0-4.5% for EUS-FNA, 1.2-7.7% for EUS-FNB, 1.9-6.7% for MIAB.

Conclusion

Based on the available evidence, MIAB and EUS-FNB seem to be most effective in terms of achieving a high diagnostic yield, with similar rates of adverse events.

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

Endoscopy and beyond (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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