title: Multicenter, prospective, crossover trial comparing the door-knocking method with the conventional method for EUS-FNA of solid pancreatic masses (with videos).
abstract: OBJECTIVE
  There are currently no prospective, controlled trials of needle puncture speed in EUS-guided FNA (EUS-FNA). In this study, we prospectively evaluated the accuracy of histological diagnosis and the tissue acquisition rate of EUS-FNA by using the door-knocking method (DKM) with a standard 22-gauge needle.
  
  
  METHODS
  From November 2013 to August 2014, 82 patients who had solid pancreatic masses underwent EUS-FNA in which the conventional method (CM) and DKM with 2 respective passes in turn were used. The primary outcomes of this study were the accuracy of histological diagnosis and the rates of tissue acquisition in 2 FNA procedures by using these 2 methods.
  
  
  RESULTS
  Although the successful tissue acquisition rate for histology was not significantly different with the DKM and CM (91.5% vs 89.0%, P = .37), the high cellularity tissue acquisition rate for histology with the DKM was significantly superior to that with the CM (54.9% vs 41.5%, P = .03). However, adequate quality rate and accuracy were not different in the DKM and CM (78.0% vs 80.5%, P = .42 and 76.8% vs 78.0%, P = .50, respectively). In the transgastric puncture group, although the adequate quality rate and accuracy were similar in the DKM and CM (84.1% vs 79.4%, P = .30 and 84.1% vs 76.2%, P = .11, respectively), the tissue acquisition rate tended to be higher with the DKM than the CM (93.7% vs 85.7%, P = .06). Moreover, the high cellularity tissue acquisition rate was significantly better with the DKM than the CM (63.5% vs 39.7%, P = .002). On the other hand, in the transduodenal puncture group, although the tissue acquisition rate was similar with the DKM and CM (84.2% vs 100%, P = .13), the adequate quality rate and accuracy were significantly lower with the DKM than with the CM (57.9% vs 84.2%, P = .03 and 52.6% vs 84.2%, P = .02, respectively).
  
  
  CONCLUSIONS
  EUS-FNA by using a 22-gauge needle with the DKM did not improve the accuracy of histological diagnosis, but enabled acquisition of a larger amount of tissue specimen by using transgastric puncture. (
  
  
  BACKGROUND
  http://www.umin.ac.jp/english/: UMIN000012127.).
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Shuntaro
authors.initials: S
authors.lastname: Mukai
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.affiliation: Department of Hepatobiliary and Pancreato-oncology, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan.
authors.forename: Reiko
authors.initials: R
authors.lastname: Ashida
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Tsuchiya
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Ikeuchi
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kamada
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Reina
authors.initials: R
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Umeda
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Tonozuka
authors.affiliation: Department of Hepatobiliary and Pancreato-oncology, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan.
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Fukutake
authors.affiliation: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan.
authors.forename: Koki
authors.initials: K
authors.lastname: Hoshi
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Fuminori
authors.initials: F
authors.lastname: Moriyasu
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Takuji
authors.initials: T
authors.lastname: Gotoda
authors.affiliation: Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Irisawa
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000175:diagnosis / Q000473:pathology; D018592:Cross-Over Studies; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D005260:Female; D006801:Humans; D008223:Lymphoma / Q000175:diagnosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000175:diagnosis / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000556:secondary; D010195:Pancreatitis / Q000175:diagnosis / Q000473:pathology; D011446:Prospective Studies