P3714 - Comparing Different Endoscopic Techniques for Tissue Sampling of Upper Gastrointestinal Subepithelial Lesions: A Network Meta-Analysis

Daryl Ramai, MD, MSc¹, Antonio Facciorusso, MD², Stefano Crinò, MD³, Alessandro Fugazz, MD⁴, Silvia Carrara, MD⁴, Marco Spadaccini, MD⁴, Matteo Colombo, MD⁴, Benedetto Mangiavillano, MD⁵, Saurabh Chandan, MD⁶, Paraskevas Gkolfakis, MD⁷, Babu Mohan, MD⁸, Cesare Hassan, MD⁹, Alessandro Repici, MD^9
1University of Utah, Salt Lake City, UT; ²University of Foggia, Foggia, Italy, Neptune, NJ; ³University of Verona, Verona, Veneto, Italy; ⁴IRCCS Humanitas Research Hospital, Milan, Lombardia, Italy; ⁵Humanitas Mater Domini, Castellanza, Lombardia, Italy; ⁶Creighton University School of Medicine, Omaha, NE; ⁷General Hospital of Nea Ionia, Athens, Attiki, Greece; ⁸University of Utah Health, Salt Lake City, UT; ⁹Humanitas Research Hospital, Milan, Lombardia, Italy

Introduction: There is limited evidence on the comparative diagnostic performance of endoscopic tissue sampling techniques of subepithelial lesions (SELs). We performed a systematic review with network meta-analysis to compare these techniques.

Methods: A systematic literature review was conducted for trials comparing the sample adequacy and diagnostic accuracy of bite-on-bite biopsy, mucosal incision-assisted biopsy (MIAB), endoscopic ultrasound fine-needle aspiration (EUS-FNA), or EUS fine-needle biopsy (FNB). Results were expressed as risk ratio (RR) and 95% confidence interval (CI).

Results: Overall, 8 RCTs were identified. On network meta-analysis, EUS-FNB resulted significantly superior to EUS-FNA in terms of sample adequacy (RR 1.20, 1.05-1.45), whereas none of the other techniques significantly outperformed EUS-FNA. Bite-on-bite biopsy resulted significantly inferior to EUS-FNB (RR 0.55, 0.33-0.98). As a consequence, EUS-FNB resulted as the best technique (SUCRA 0.90) followed by MIAB (SUCRA 0.83), whereas bite-on-bite biopsy showed the poorest performance. Similar results were observed with diagnostic accuracy analysis. When considering lesions < 2 cm, EUS-FNB did not result significantly superior to EUS-FNA in terms of sample adequacy (RR 0.82, 0.61-1.17) nor of diagnostic accuracy (RR 1.21, 0.85-1.73). On the other hand, MIAB determined significantly higher accuracy rates as compared to EUS-FNA (RR 1.68, 1.02-2.88). As a consequence, MIAB ranked as the best intervention for lesions < 2 cm (SUCRA score 0.86 for adequacy and 0.91 for accuracy), with EUS-FNB only slightly superior to EUS-FNA. When rapid on-site cytological evaluation (ROSE) was available, no difference between EUS-FNB and EUS-FNA was observed (RR 1.21, 0.90-1.65 for adequacy and RR 1.45, 0.93-2.05 for accuracy), nor between MIAB and EUS-FNA (RR 1.15, 0.71-1.87 for adequacy and RR 1.28, 0.80-2.07 for accuracy).

Discussion: EUS-FNB and MIAB seem to provide better performances, with bite-on-bite biopsy significantly inferior to the other techniques. MIAB seems to be the best option for smaller lesions, whereas EUS-FNA is still competitive when ROSE is available.



Disclosures:


Daryl Ramai, MD, MSc¹, Antonio Facciorusso, MD², Stefano Crinò, MD³, Alessandro Fugazz, MD⁴, Silvia Carrara, MD⁴, Marco Spadaccini, MD⁴, Matteo Colombo, MD⁴, Benedetto Mangiavillano, MD⁵, Saurabh Chandan, MD⁶, Paraskevas Gkolfakis, MD⁷, Babu Mohan, MD⁸, Cesare Hassan, MD⁹, Alessandro Repici, MD⁹. P3714 - Comparing Different Endoscopic Techniques for Tissue Sampling of Upper Gastrointestinal Subepithelial Lesions: A Network Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.