Puncture of submucosal and extrinsic tumors: is there a clinical need? Puncture techniques and their accuracy.

Cytological or histological tissue diagnosis of submucosal and extrinsic tumors adjacent to the upper gastrointestinal tract is required in many patients for differentiation of benign and malignant lesions. In the case of a submucosal lesion, it can be most efficiently obtained by transendoscopic needle puncture using a conventional endoscope and a guillotine needle device sampling histological tissue specimen. In the case of an extrinsic paraesophageal mass lesion in the dorsal mediastinum, transmural EUS-guided fine needle aspiration puncture appears to be an efficient technique for the differentiation of benign and malignant lesions. However, for transgastral or transduodenal EUS-guided FNA puncture, especially of pancreatic tumors, new prototypes of aspiration catheters with an extending steel needle are mandatory to obtain diagnostic tissue specimens.