title: High and low negative pressure suction techniques in EUS-guided fine-needle tissue acquisition by using 25-gauge needles: a multicenter, prospective, randomized, controlled trial.
abstract: BACKGROUND
  EUS-guided FNA (EUS-FNA) has a high diagnostic accuracy for pancreatic diseases. However, although most reports have typically focused on cytology, histological tissue quality has rarely been investigated. The effectiveness of EUS-FNA combined with high negative pressure (HNP) suction was recently indicated for tissue acquisition, but has not thus far been tested in a prospective, randomized clinical trial.
  
  
  OBJECTIVE
  To evaluate the adequacy of EUS-FNA with HNP for the histological diagnosis of pancreatic lesions by using 25-gauge needles.
  
  
  METHODS
  Prospective, single-blind, randomized, controlled crossover trial.
  
  
  METHODS
  Seven tertiary referral centers.
  
  
  METHODS
  Patients referred for EUS-FNA of pancreatic solid lesions. From July 2011 to April 2012, 90 patients underwent EUS-FNA of pancreatic solid masses by using normal negative pressure (NNP) and HNP with 2 respective passes. The order of the passes was randomized, and the sample adequacy, quality, and histology were evaluated by a single expert pathologist.
  
  
  METHODS
  EUS-FNA by using NNP and HNP.
  
  
  METHODS
  The adequacy of tissue acquisition and the accuracy of histological diagnoses made by using the EUS-FNA technique with HNP.
  
  
  RESULTS
  We found that 72.2% (65/90) and 90% (81/90) of the specimens obtained using NNP and HNP, respectively, were adequate for histological diagnosis (P = .0003, McNemar test). For 73.3% (66/90) and 82.2% (74/90) of the specimens obtained by using NNP and HNP, respectively, an accurate diagnosis was achieved (P = .06, McNemar test). Pancreatitis developed in 1 patient after this procedure, which subsided with conservative therapy.
  
  
  CONCLUSIONS
  This was a single-blinded, crossover study.
  
  
  CONCLUSIONS
  Biopsy procedures that combine the EUS-FNA with HNP techniques are superior to EUS-FNA with NNP procedures for tissue acquisition. (
  
  
  BACKGROUND
  UMIN000005939.).
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Taiki
authors.initials: T
authors.lastname: Kudo
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawakami
authors.affiliation: Department of Medical Oncology and Hematology, Sapporo Medical University, Sapporo, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hayashi
authors.affiliation: The First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yasuda
authors.affiliation: Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Mukai
authors.affiliation: Department of Gastroenterology and Hepatology, Mie University, Mie, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Inoue
authors.affiliation: Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Katanuma
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Kawakubo
authors.affiliation: Department of Medical Oncology and Hematology, Sapporo Medical University, Sapporo, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Ishiwatari
authors.affiliation: The First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
authors.forename: Shinpei
authors.initials: S
authors.lastname: Doi
authors.affiliation: Department of Gastroenterology and Hepatology, Mie University, Mie, Japan.
authors.forename: Reiko
authors.initials: R
authors.lastname: Yamada
authors.affiliation: Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Maguchi
authors.affiliation: Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.affiliation: Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Mitsuhashi
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Sakamoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology; D018267:Carcinoma, Acinar Cell / Q000473:pathology*; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology*; D018592:Cross-Over Studies; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology*; D010179:Pancreas / Q000473:pathology*; D010182:Pancreatic Diseases / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000473:pathology*; D010195:Pancreatitis / Q000473:pathology*; D011312:Pressure; D016037:Single-Blind Method; D013396:Suction / Q000379:methods