Heparin Wet Suction Versus Conventional Suction in Endoscopic Ultrasound-Guided Fine-Needle Biopsy for Solid Pancreatic Masses: A Multicenter Randomized Crossover Study.
Hyung Ku Chon, Dong Kee Jang, Woo Hyun Paik et al.
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In 30 seconds
This multicenter, single-blinded randomized crossover trial compared heparin wet suction (HWST) with conventional suction (CST) during EUS-guided fine-needle biopsy using a 22-gauge needle in patients with solid pancreatic masses. Among 170 patients who received both techniques, diagnostic yield was 82.9% (95% CI, 76.6-87.9) with HWST and 83.5% (95% CI, 77.2-88.4) with CST; the paired difference was -0.6 percentage points (95% CI, -6.7 to 5.5; exact McNemar p = 1.000). Technical success and immunohistochemistry adequacy were also similar, with one self-limiting bleeding event during CST.
Key findings
- Diagnostic yield was 82.9% (95% CI, 76.6-87.9) with HWST and 83.5% (95% CI, 77.2-88.4) with CST.
- The paired diagnostic-yield difference was -0.6 percentage points (95% CI, -6.7 to 5.5; exact McNemar p = 1.000).
- Technical success was 100% with both techniques; IHC adequacy was 80.6% with HWST and 78.8% with CST.
- Sequential sampling produced a combined diagnostic yield of 91.2% (95% CI, 86.0-94.6); one self-limiting bleeding event occurred during CST.
Why it matters
The trial found no meaningful diagnostic-yield advantage for heparin wet suction over conventional suction with this needle and population. This helps frame technique selection around comparable observed performance rather than an assumed benefit from preventing intraneedle clotting. The higher yield after sequential sampling is potentially relevant, but the authors caution that it needs further validation.
What to keep in mind
The comparison used one pass per technique with a specific 22-gauge needle in patients with solid pancreatic masses; the sequential-sampling result requires further validation.