Comparison Between Two Tissue Acquisition Techniques by Endoscopic Ultrasound. (EUS)

Digestive Cancer Clinical Trial

— EUS  

Official title:

Capillarity Versus Wet Technique. Comparison Between Two Methods of Tissue Acquisition Guided by Endoscopic Ultrasound.

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03460197
• Other study ID #: R-2016-3601-190
• Status: Completed
• Start date: April 20, 2018
• Est. completion date: July 20, 2018

Study information

• Verified date: February 2019
• Source: Instituto Mexicano del Seguro Social
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

There are various techniques to obtain tissue samples by using fine needle guided by endoscopic ultrasound (EUS). These techniques attempt to obtain the most adequate material with the best quantity and quality for analysis. Currently studies that compare the results concerning capillary technique versus wet technique are not available. In this sense, the authors consider necessary to explore both techniques documenting the results that can define which could be the best method so that it can routinely be used in cases of digestive neoplasia.

Description:

The aim of the study will be compare both techniques guided by endoscopic ultrasound (Capillarity versus Wet) and identify which obtains the best sample quality for histopathology analysis as tissue acquisition method in patients diagnosed with tumors of pancreas, biliary tract, liver or lymph nodes.

The researchers are planning a prospective, pilot study in 30 subjects. All patients will be submitted to both techniques of tissue acquisition (capillarity versus wet) in the same procedure of endoscopic ultrasound. Obtained samples for histopathology analysis will be submitted to a blind examination by two different pathologists.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 30
• Est. completion date: July 20, 2018
• Est. primary completion date: June 20, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

• Low or moderate suspicious of malignancy lesion in pancreas, liver or metastatic lymph nodes

• Initial diagnosis according to the characterization by endoscopic ultrasound

Exclusion Criteria:

• Bleeding

• Complications during biopsy procedure

• Needed to use procedures other than those contemplated in the study.

• Patients who not require endoscopic ultrasound evaluation

• Patients who not accept the procedures of the study

Related Conditions & MeSH terms

• Digestive Cancer

Intervention

Procedure:
• Endoscopic Ultrasound-Guided Fine-Needle Aspiration
Patients will be submitted to both techniques of tissue acquisition in the same procedure of endoscopic ultrasound. Capillarity technique, requires not remove the stiletto from the needle until the punctures are done for the biopsy sampling. Wet suction technique, requires saline solution to replace the air column. Samplings will be placed in two different jars, where Jar 1 corresponds to Capillarity Technique sampling and Jar 2 to Wet Technique. Once the sampling preparation is concluded will be send to the Pathology Department to be subsequently blindly analyzed by two independent pathologists, that means they would not be aware of the tissue acquisition method used in each of the microscopic slides to analyze.

Locations

Country	Name	City	State
Mexico	Centro Medico Nacional Siglo XXI. UMAE Hospital de Especialidades	Mexico City	Cdmx

Sponsors (1)

Lead Sponsor	Collaborator
Instituto Mexicano del Seguro Social

Country where clinical trial is conducted

Mexico, 

References & Publications (21)

Ang TL, Kwek ABE, Wang LM. Diagnostic Endoscopic Ultrasound: Technique, Current Status and Future Directions. Gut Liver. 2018 Sep 15;12(5):483-496. doi: 10.5009/gnl17348. Review. — View Citation

Attam R, Arain MA, Bloechl SJ, Trikudanathan G, Munigala S, Bakman Y, Singh M, Wallace T, Henderson JB, Catalano MF, Guda NM. "Wet suction technique (WEST)": a novel way to enhance the quality of EUS-FNA aspirate. Results of a prospective, single-blind, randomized, controlled trial using a 22-gauge needle for EUS-FNA of solid lesions. Gastrointest Endosc. 2015;81(6):1401-7. doi: 10.1016/j.gie.2014.11.023. Epub 2015 Feb 27. — View Citation

Bang JY, Hawes RH, Varadarajulu S. EUS-guided tissue acquisition: things are not always what they seem. Gastrointest Endosc. 2015 May;81(5):1300-1. doi: 10.1016/j.gie.2014.12.044. — View Citation

Hedenström P, Demir A, Khodakaram K, Nilsson O, Sadik R. EUS-guided reverse bevel fine-needle biopsy sampling and open tip fine-needle aspiration in solid pancreatic lesions - a prospective, comparative study. Scand J Gastroenterol. 2018 Feb;53(2):231-237. doi: 10.1080/00365521.2017.1421704. Epub 2018 Jan 4. — View Citation

Hollerbach S, Juergensen C, Hocke M, Freund U, Wellmann A, Burmester E. [EUS-FNA: how to improve biopsy results? An evidence based review]. Z Gastroenterol. 2014 Sep;52(9):1081-92. doi: 10.1055/s-0034-1385133. Epub 2014 Sep 8. Review. German. — View Citation

Iwashita T, Nakai Y, Samarasena JB, Park DH, Zhang Z, Gu M, Lee JG, Chang KJ. High single-pass diagnostic yield of a new 25-gauge core biopsy needle for EUS-guided FNA biopsy in solid pancreatic lesions. Gastrointest Endosc. 2013 Jun;77(6):909-15. doi: 10.1016/j.gie.2013.01.001. Epub 2013 Feb 20. — View Citation

Jani BS, Rzouq F, Saligram S, Lim D, Rastogi A, Bonino J, Olyaee M. Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Pancreatic Lesions: A Systematic Review of Technical and Procedural Variables. N Am J Med Sci. 2016 Jan;8(1):1-11. doi: 10.4103/1947-2714.175185. Review. — View Citation

Lakhtakia S. Complications of diagnostic and therapeutic Endoscopic Ultrasound. Best Pract Res Clin Gastroenterol. 2016 Oct;30(5):807-823. doi: 10.1016/j.bpg.2016.10.008. Epub 2016 Oct 28. Review. — View Citation

Panic N, Larghi A. Techniques for endoscopic ultrasound-guided fine-needle biopsy. Gastrointest Endosc Clin N Am. 2014 Jan;24(1):83-107. doi: 10.1016/j.giec.2013.08.010. Review. — View Citation

Paquin SC, Sahai AV. Techniques for EUS-guided FNA cytology. Gastrointest Endosc Clin N Am. 2014 Jan;24(1):71-81. doi: 10.1016/j.giec.2013.08.007. Review. — View Citation

Polkowski M, Jenssen C, Kaye P, Carrara S, Deprez P, Gines A, Fernández-Esparrach G, Eisendrath P, Aithal GP, Arcidiacono P, Barthet M, Bastos P, Fornelli A, Napoleon B, Iglesias-Garcia J, Seicean A, Larghi A, Hassan C, van Hooft JE, Dumonceau JM. Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline - March 2017. Endoscopy. 2017 Oct;49(10):989-1006. doi: 10.1055/s-0043-119219. Epub 2017 Sep 12. — View Citation

Puri R, Vilmann P, Saftoiu A, Skov BG, Linnemann D, Hassan H, Garcia ES, Gorunescu F. Randomized controlled trial of endoscopic ultrasound-guided fine-needle sampling with or without suction for better cytological diagnosis. Scand J Gastroenterol. 2009;44(4):499-504. doi: 10.1080/00365520802647392. — View Citation

Shah JN, Muthusamy VR. Minimizing complications of endoscopic ultrasound and EUS-guided fine needle aspiration. Gastrointest Endosc Clin N Am. 2007 Jan;17(1):129-43, vii-viii. Review. — View Citation

Varadarajulu S, Hasan MK, Bang JY, Hebert-Magee S, Hawes RH. Endoscopic ultrasound-guided tissue acquisition. Dig Endosc. 2014 Jan;26 Suppl 1:62-9. doi: 10.1111/den.12146. Epub 2013 Aug 28. Review. — View Citation

Vilmann P, Seicean A, Saftoiu A. Tips to overcome technical challenges in EUS-guided tissue acquisition. Gastrointest Endosc Clin N Am. 2014 Jan;24(1):109-24. doi: 10.1016/j.giec.2013.08.009. Review. — View Citation

Wang J, Wu X, Yin P, Guo Q, Hou W, Li Y, Wang Y, Cheng B. Comparing endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) versus fine needle biopsy (FNB) in the diagnosis of solid lesions: study protocol for a randomized controlled trial. Trials. 2016 Apr 12;17:198. doi: 10.1186/s13063-016-1316-2. — View Citation

Wani S, Muthusamy VR, Komanduri S. EUS-guided tissue acquisition: an evidence-based approach (with videos). Gastrointest Endosc. 2014 Dec;80(6):939-59.e7. doi: 10.1016/j.gie.2014.07.066. Review. — View Citation

Wee E, Lakhtakia S, Gupta R, Sekaran A, Kalapala R, Monga A, Arjunan S, Reddy DN. Endoscopic ultrasound guided fine-needle aspiration of lymph nodes and solid masses: factors influencing the cellularity and adequacy of the aspirate. J Clin Gastroenterol. 2012 Jul;46(6):487-93. doi: 10.1097/MCG.0b013e31824432cb. — View Citation

Wiersema MJ, Kochman ML, Cramer HM, Tao LC, Wiersema LM. Endosonography-guided real-time fine-needle aspiration biopsy. Gastrointest Endosc. 1994 Nov-Dec;40(6):700-7. — View Citation

Yamao K, Bhatia V, Mizuno N, Sawaki A, Shimizu Y, Irisawa A. Interventional endoscopic ultrasonography. J Gastroenterol Hepatol. 2009 Apr;24(4):509-19. doi: 10.1111/j.1440-1746.2009.05783.x. Review. — View Citation

Yamao K, Ohashi K, Mizutani S, Furukawa T, Watanabe Y, Nakamura T, Suzuki T, Takeda K. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for the diagnosis of digestive diseases. Endoscopy. 1998 Aug;30 Suppl 1:A176-8. — View Citation

* Note: There are 21 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	The classification of Papanicolaou was used for the terminology in pancreatobiliary cytological evaluation of biopsy samples.	I.- Non-diagnostic: Specimen does not provide information about whether the lesion is cystic or solid.; II.- Negative (for malignancy): Specimen has adequate cellularity and / or extracellular material that defines a lesion that is identified by image.; III.- Atypical: There are cells with architectural, nuclear or cytoplasmic that are not consistent with reactive changes. However, these findings are not conclusive to diagnose malignancy or suspected of malignancy.; IV.- Neoplastic: benign and others. Neoplasic benign: Sample has elements of benign neoplasm. Neoplastic others: May be is a premalignant lesion like low-level dysplasia, intermediate or high grade dysplasia or a low grade neoplasm with malignant behavior.; V.- Suspected of malignancy: Cytological characteristics support the Diagnosis of malignancy but quantitatively or qualitatively is not enough to confirm it.; VI.- Positive / malignant: Cytological changes are unequivocal of malignancy.	4 months once the study has begun