使用带线夹法对胃小上皮下病变进行牵引辅助内镜超声引导下细针穿刺活检：随机对照试验（附视频）
Traction-assisted endoscopic ultrasound-guided fine-needle biopsy using the clip-with-thread method for small gastric subepithelial lesions: Randomized controlled trial (with video).
作者信息
Minoda Yosuke, Suzuki Yusuke, Ogino Haruei, Nagatomo Shuzaburo, Bai Xiaopeng, Esaki Mitsuru, Wada Masafumi, Tanaka Yoshimasa, Hata Yoshitaka, Fujimori Nao, Umekita Shinya, Tsurumaru Daisuke, Ota Mitsuhiko, Oki Eiji, Ihara Eikichi, Ogawa Yoshihiro
机构信息
Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Endoscopic Diagnostics and Therapeutics, Kyushu University Hospital, Fukuoka, Japan.
出版信息
Dig Endosc. 2025 May;37(5):512-520. doi: 10.1111/den.14977. Epub 2025 Jan 9.
OBJECTIVES
Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) is the gold standard for diagnosing gastric subepithelial lesions (SELs), but diagnosing lesions smaller than 20 mm remains challenging. We developed traction-assisted EUS-FNB (TA-EUS-FNB) using the clip-with-thread method to enhance diagnostic accuracy by stabilizing the lesion and providing counter-traction for easier needle access. This study evaluates the effectiveness of TA-EUS-FNB in diagnosing small gastric SELs.
METHODS
In this prospective, randomized, controlled cross-over trial (August 2019-November 2022), 30 patients with gastric SELs <20 mm were randomized to undergo TA-EUS-FNB or conventional EUS-FNB. Each patient underwent four punctures, two per method. The primary end-point was the adequate tissue sampling rate for both techniques. Secondary end-points included diagnostic yield and performance (sensitivity and specificity) in distinguishing gastrointestinal stromal tumors (GISTs) from non-GISTs.
RESULTS
The mean tumor size was 15.0 mm, with diagnoses comprising GISTs (n = 15, 50%), leiomyomas (n = 8, 26.7%), schwannomas (n = 2, 6.7%), aberrant pancreas (n = 3, 10%), and inflammation (n = 2, 6.7%). TA-EUS-FNB demonstrated a significantly higher adequate-tissue sampling rate (90% vs. 66.7%, P = 0.035) and diagnostic yield (86.7% vs. 63.3%, P = 0.037) than conventional EUS-FNB. Sensitivity (86.7%, 95% confidence interval [CI] 62.1-96.3% vs. 66.7%, 95% CI 41.7-84.8%; P = 0.20) and specificity (100%, 95% CI 79.6-100% vs. 100%, 95% CI 79.6-100%) were comparable between the methods. No adverse events were observed in the study.
CONCLUSION
TA-EUS-FNB demonstrated superior tissue sampling rates and diagnostic yield for SELs <20 mm compared to conventional EUS-FNB, making it a viable option. Controlling lesion mobility is essential for successful EUS-FNB in small SELs.
目的
内镜超声引导下细针穿刺抽吸/活检（EUS-FNA/B）是诊断胃黏膜下病变（SELs）的金标准，但诊断小于20mm的病变仍具有挑战性。我们采用带线夹法开发了牵引辅助EUS-FNB（TA-EUS-FNB），通过稳定病变并提供反向牵引力以便更轻松地进针，从而提高诊断准确性。本研究评估TA-EUS-FNB在诊断小胃SELs中的有效性。
方法
在这项前瞻性、随机、对照交叉试验（2019年8月至2022年11月）中，30例胃SELs<20mm的患者被随机分配接受TA-EUS-FNB或传统EUS-FNB。每位患者进行四次穿刺，每种方法各两次。主要终点是两种技术的充足组织采样率。次要终点包括区分胃肠道间质瘤（GISTs）与非GISTs的诊断率和性能（敏感性和特异性）。
结果
平均肿瘤大小为15.0mm，诊断包括GISTs（n=15，50%）、平滑肌瘤（n=8，26.7%）、神经鞘瘤（n=2，6.7%）、异位胰腺（n=3，10%）和炎症（n=2，6.7%）。与传统EUS-FNB相比，TA-EUS-FNB显示出显著更高的充足组织采样率（90%对66.7%，P=0.035）和诊断率（86.7%对63.3%，P=0.037）。两种方法之间的敏感性（86.7%，95%置信区间[CI]62.1-96.3%对66.7%，95%CI41.7-84.8%；P=0.20）和特异性（100%，95%CI79.6-100%对100%，95%CI79.6-100%）相当。研究中未观察到不良事件。
结论
与传统EUS-FNB相比，TA-EUS-FNB在诊断<20mm的SELs时显示出更高的组织采样率和诊断率，使其成为一种可行的选择。控制病变的移动性对于小SELs中成功进行EUS-FNB至关重要。
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