title: Randomized Trial Comparing the Flexible 19G and 25G Needles for Endoscopic Ultrasound-Guided Fine Needle Aspiration of Solid Pancreatic Mass Lesions.
abstract: OBJECTIVE
  Although a large gauge needle can procure more tissue at endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), its advantage over smaller needles is unclear. This study compared flexible 19G and 25G needles for EUS-FNA of solid pancreatic masses.
  
  
  METHODS
  This was a randomized trial of patients undergoing EUS-FNA of pancreatic masses using flexible 19G or 25G needle. Main outcome measure was to compare median number of passes for on-site diagnosis. Secondary measures were to compare specimen bloodiness, complications, technical failures, and histological core tissue procurement.
  
  
  RESULTS
  One hundred patients were randomized to EUS-FNA using flexible 19G or 25G needle. Median of 1 pass was required to achieve on-site diagnosis of 96% and 92% (P = 0.68) in 19G and 25G cohorts. There was no significant difference in technical failure (0% vs 2%, P = 0.99) or adverse events (2% vs 0%, P = 0.99) between 19G and 25G cohorts. Although histological core tissue procurement was significantly better with flexible 19G needle (88% vs 44%, P < 0.001), specimens were bloodier (severe bloodiness, 36% vs 4%; P < 0.001).
  
  
  CONCLUSIONS
  As there is no significant difference in the performance of flexible 19G and 25G needles, needle choice for sampling pancreatic masses should be based on endoscopist preference and need for histology.
authors.affiliation: From the *Division of Gastroenterology and Hepatology and †Department of Pathology, University of Alabama at Birmingham, Birmingham, AL; and ‡Center for Interventional Endoscopy, Florida Hospital, Orlando, FL.
authors.forename: Jayapal
authors.initials: J
authors.lastname: Ramesh
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Bang
authors.forename: Shantel
authors.initials: S
authors.lastname: Hebert-Magee
authors.forename: Jessica
authors.initials: J
authors.lastname: Trevino
authors.forename: Isam
authors.initials: I
authors.lastname: Eltoum
authors.forename: Andra
authors.initials: A
authors.lastname: Frost
authors.forename: Muhammad K
authors.initials: MK
authors.lastname: Hasan
authors.forename: Amy
authors.initials: A
authors.lastname: Logue
authors.forename: Robert
authors.initials: R
authors.lastname: Hawes
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000407:Alabama; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology* / Q000628:therapy; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000009:adverse effects / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005431:Florida; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D018358:Neuroendocrine Tumors / Q000473:pathology* / Q000628:therapy; D010179:Pancreas / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000628:therapy; D050500:Pancreatitis, Chronic / Q000473:pathology* / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis