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Diagnostic efficacy of endoscopic ultrasound-guided needle sampling for upper gastrointestinal subepithelial lesions: a meta-analysis

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Abstract

Background

An increasing number of studies have been conducted on the use of endoscopic ultrasound (EUS)-guided needle sampling for upper gastrointestinal subepithelial lesions (SEL). However, reported diagnostic efficacy varies greatly.

Objective

To summarize up current evidences on the diagnostic efficacy of EUS-guided needle sampling for upper GI SEL.

Method

A reproducible strategy was used to search four databases. Search results were evaluated for eligibility, and the quality of eligible studies was assessed by QUADAS-2. Pooled efficacy of EUS-guided needle sampling in upper GI SEL was calculated. Procedure-related complications, diagnostic errors, and independent factors related to a higher success rate were also recorded and analyzed.

Results

Seventeen studies, comprising 978 attempts of EUS-guided needle sampling, were included in a meta-analysis. Pooled diagnostic rate of EUS-guided needle sampling was 59.9 %, with a heterogeneity I 2 of 55.2 %. Subgroup analysis showed no difference in diagnostic rate among fine needle aspiration (FNA), trucut needle biopsy (TCB), and fine needle biopsy (FNB), or among 19-, 22-, and 25-G needles. Subgroup analysis and meta-regression suggested that the cell block method might be correlated with a higher diagnostic rate. Few severe complications were reported. Diagnosis errors were rare.

Conclusion

EUS-guided needle sampling is a safe, but only moderately effective method for pathology diagnosis of upper GI SEL. Choice of FNA/TCB/FNB, or 19 G/22 G/25 G does not seem to alter the overall diagnostic rate.

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Acknowledgments

This study was supported by the grants from the Major Project of Shanghai Municipal Science and Technology Committee (11411950502 and 13411950801), Academic Leader Training Project of Shanghai Municipal+ Commission of Health and Family Planning (13B038), National Natural Science Foundation of China (81302098, 81201902, 81470811, and 81401930), and Natural Science Foundation of Shanghai (13ZR1452300). No other financial relationships relevant to this publication were disclosed. We appreciate the effort of statistician Hui-Xun Jia, from Clinical Statistics Center, Fudan University Shanghai Cancer Center, in reviewing statistical methods used in this paper.

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    Authors and Affiliations

    1. Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, People’s Republic of China

      Xiao-Cen Zhang, Quan-Lin Li, Li-Qing Yao, Mei-Dong Xu, Yi-Qun Zhang, Yun-Shi Zhong, Wei-Feng Chen & Ping-Hong Zhou

    2. Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark

      Yong-Fu Yu

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    Xiao-Cen Zhang, Quan-Lin Li, Yong-Fu Yu, Li-Qing Yao, Mei-Dong Xu, Yi-Qun Zhang, Yun-Shi Zhong, Wei-Feng Chen, and Ping-Hong Zhou have no conflicts of interest or financial ties to disclose.

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    Dr. Xiao-Cen Zhang and Dr. Quan-Lin Li have contributed equally to this work.

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    Zhang, XC., Li, QL., Yu, YF. et al. Diagnostic efficacy of endoscopic ultrasound-guided needle sampling for upper gastrointestinal subepithelial lesions: a meta-analysis. Surg Endosc 30, 2431–2441 (2016). https://doi.org/10.1007/s00464-015-4494-1

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