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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT05825729
Other study ID # TEC-EUS
Secondary ID
Status Recruiting
Phase Phase 4
First received
Last updated
Start date June 27, 2023
Est. completion date May 22, 2025

Study information

Verified date November 2023
Source Hospital Universitario Insular Gran Canaria
Contact Guillermo Perez-Aguado, MD
Phone +34647369686
Email guiperez92@gmail.com
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Endoscopic ultrasound (EUS) is a widely recognized tool for over 30 years for diagnosing intra-abdominal lesions and gastrointestinal cancers, especially pancreatic neoplasia. In most hospitals, it is the preferred method for sampling using fine-needle aspiration (EUS-FNA) or histology needle aspiration biopsy (EUS-FNB) to obtain cytological and histological material for an anatomopathological diagnosis. It is also recognized by current oncology guidelines. Numerous factors can affect the efficacy of this technique, such as the needle size, type (cytology or histology), number of passes made on the lesion, the presence or absence of a pathologist in the endoscopy room, the experience of the endoscopist, etc. Currently, EUS-FNA or EUS-FNB are recommended interchangeably for diagnosis; however, it appears that histology needles (EUS-FNB) allow for greater diagnostic efficacy by obtaining a cellular block with fewer passes, which allows for more advanced anatomopathological analysis (such as immunohistochemistry or molecular analysis). Regarding the technique for performing the puncture and acquiring the sample, current European guidelines recommend sampling using EUS-FNA or FNB by dry suction with a 10 mL syringe. However, other recognized techniques, such as using a stylet with the "slow-pull" technique (not positioning for or against) or liquid biopsy (which could obtain larger cellular blocks compared to dry puncture), are widely used and could obtain better samples, but there is no clear consensus currently. Investigators' goal is to conduct a randomized clinical trial of three EUS-FNB techniques (dry puncture vs slow-pull vs wet puncture) used in daily clinical practice to evaluate which of the three techniques has greater efficacy in cytological and pathological diagnosis.


Recruitment information / eligibility

Status Recruiting
Enrollment 330
Est. completion date May 22, 2025
Est. primary completion date May 22, 2025
Accepts healthy volunteers Accepts Healthy Volunteers
Gender All
Age group 18 Years and older
Eligibility Inclusion criteria - Age = 18 years - Patients referred for EUS-FNB after imaging tests (CT, MRI, or abdominal ultrasound) of pancreatic, non-pancreatic intraabdominal, mediastinal, or pelvic lesions greater than 1 cm. - Signed informed consent. Exclusion criteria - Coagulopathy (INR> 1.5) or thrombocytopenia (<50,000) - Severe heart or respiratory failure that contraindicates sedation. - Use of anticoagulants and antiplatelet agents that cannot be suspended. - Use of a needle of a different gauge to 22G - Refusal to sign informed consent.

Study Design


Related Conditions & MeSH terms


Intervention

Diagnostic Test:
Dry suction technique (A)
Using a linear echoendoscope, such as Pentax or Olympus, after identifying the lesion and deciding where to perform the EUS-FNB, always checking that there are no vessels on the eco-Doppler that would prevent puncture, a 22G Cook "Echo-Tip Procore" histology needle will be used to perform the following techniques of the described arms. - Dry suction puncture: Once the lesion is located and punctured, the stylet will be completely removed, and a 10 mL syringe with a vacuum of 10 mL will be attached. In each pass, the needle will be advanced and retracted 20-30 times according to the standard technique. The suction will then be closed, and the needle will be removed. The "fanning" technique will be performed whenever possible.
Slow-pull technique (B)
Using a linear echoendoscope, such as Pentax or Olympus, after identifying the lesion and deciding where to perform the EUS-FNB, always checking that there are no vessels on the eco-Doppler that would prevent puncture, a 22G Cook "Echo-Tip Procore" histology needle will be used to perform the following techniques of the described arms.
Wet suction technique (C)
Using a linear echoendoscope, such as Pentax or Olympus, after identifying the lesion and deciding where to perform the EUS-FNB, always checking that there are no vessels on the eco-Doppler that would prevent puncture, a 22G Cook "Echo-Tip Procore" histology needle will be used to perform the following techniques of the described arms. - Wet suction technique: Prior to puncture, the stylet should be removed and the needle should be flushed with 1-2 ml of physiological saline and a 10 ml vacuum syringe with 3-5 ml of saline should be attached. In each pass, the needle should be moved forward and backward 20-30 times. Aspiration should be opened as the needle advances and closed as it is withdrawn. Afterwards, the aspiration should be closed and the needle should be removed. The "fanning" technique should be performed whenever possible.

Locations

Country Name City State
Spain Complejo Hospitalario Universitario Materno Infantil Las Palmas De Gran Canaria Las Palmas
Spain Hospital Universitario Doctor Negrin de Gran Canaria Las Palmas De Gran Canaria Las Palmas

Sponsors (1)

Lead Sponsor Collaborator
Hospital Universitario Insular Gran Canaria

Country where clinical trial is conducted

Spain, 

Outcome

Type Measure Description Time frame Safety issue
Primary Diagnostic Efficacy Analyze the diagnostic efficacy of the three techniques used in obtaining echoendoscopic biopsies of solid lesions: Slow-pull vs EUS-FNB with standard dry aspiration vs EUS-FNB with wet aspiration.
The diagnostic efficacy will be evaluated in terms of sensibility, specificity, positive predictive value and negative predictive value.
2 years
Primary Quality of samples Tissue integrity A: presence of tissue cylinder (intact piece of tissue measuring at least 550 microns in the microscope field of view).B: presence of tissue cylinder that does not meet criteria but allows for a diagnosis based on cellular morphology.C: No viable intact tissue exists.Cellularity A: Satisfactory, presence of > 4 clusters suitable for cytological interpretation with a minimum of 10 cells.B: Adequate, presence of 2-4 clusters suitable for cytological interpretation with a minimum of 10 cells.C: Inadequate, < 2 clusters suitable for cytological interpretation or non-representative sample or a cell count < 50 with clear nuclear structures.Blood presence A: Minimal contamination, erythrocytes in < 25% B: Moderate contamination, erythrocytes in 25-50% C: Significant contamination, erythrocytes in > 50% 2 years
Secondary Rapid On Site Evaluation (ROSE) Impact of the presence of ROSE on the different EUS-FNB techniques 2 years
Secondary Endoscopist's experience Evaluate the influence of the endoscopist's experience on the results of the three techniques. The experience of the endoscopic investigator will be based on the number of procedures divided in: more than 500 EUS-FNB, between 500-250 EUS-FNB and less than 250 EUS-FNB 2 years
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