Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Mucosal incision-assisted biopsy versus endoscopic ultrasound-assisted tissue acquisition for subepithelial lesions: a systematic review and meta-analysis

  • Suprabhat Giri (Nizam's Institute of Medical Sciences) ;
  • Shivaraj Afzalpurkar (Institute of Gastrosciences and Liver, Apollo Multispecialty Hospital) ;
  • Sumaswi Angadi (Nizam's Institute of Medical Sciences) ;
  • Sridhar Sundaram (Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital)
  • Received : 2022.04.22
  • Accepted : 2022.06.16
  • Published : 2022.09.30
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Abstract

Background/Aims: Mucosal incision-assisted biopsy (MIAB) for tissue acquisition (TA) from subepithelial lesions (SELs) is emerging as an alternative to endoscopic ultrasound (EUS)-guided TA. Only a limited number of studies compared the diagnostic utility of MIAB and EUS for upper gastrointestinal (GI) SELs; therefore, we conducted this systematic review and meta-analysis. Methods: A comprehensive literature search from January 2020 to January 2022 was performed to compare the diagnostic accuracy and safety of MIAB and EUS-guided TA for upper GI SELs. Results: Seven studies were included in this meta-analysis. The pooled technical success rate (risk ratio [RR], 0.96; 95% confidence interval [CI], 0.89-1.04) and procedural time (mean difference=-4.53 seconds; 95% CI, -22.38 to 13.31] were comparable between both the groups. The overall chance of obtaining a positive diagnostic yield was lower with EUS than with MIAB for all lesions (RR, 0.83; 95% CI, 0.71-0.98) but comparable when using a fine-needle biopsy needle (RR, 0.93; 95% CI, 0.83-1.04). The positive diagnostic yield of MIAB was higher for lesions <20 mm (RR, 0.75; 95% CI, 0.63-0.89). Six studies reported no adverse events. Conclusions: MIAB can be considered an effective alternative to EUS-guided TA for upper GI SELs without an increased risk of adverse events.

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References

  1. Humphris JL, Jones DB. Subepithelial mass lesions in the upper gastrointestinal tract. J Gastroenterol Hepatol 2008;23:556-566. 
  2. Hawes R, Fockens P, Varadarajulu S. Endosonography. 4th ed. Philadelphia: Elsevier; 2018. 
  3. Polkowski M. Endoscopic ultrasound and endoscopic ultrasound-guided fine-needle biopsy for the diagnosis of malignant submucosal tumors. Endoscopy 2005;37:635-645. 
  4. Buscaglia JM, Nagula S, Jayaraman V, et al. Diagnostic yield and safety of jumbo biopsy forceps in patients with subepithelial lesions of the upper and lower GI tract. Gastrointest Endosc 2012;75:1147-1152. 
  5. Akahoshi K, Sumida Y, Matsui N, et al. Preoperative diagnosis of gastrointestinal stromal tumor by endoscopic ultrasound-guided fine needle aspiration. World J Gastroenterol 2007;13:2077-2082. 
  6. Attila T, Aydin O. Lesion size determines diagnostic yield of EUSFNA with onsite cytopathologic evaluation for upper gastrointestinal subepithelial lesions. Turk J Gastroenterol 2018;29:436-441. 
  7. van Riet PA, Erler NS, Bruno MJ, et al. Comparison of fine-needle aspiration and fine-needle biopsy devices for endoscopic ultrasound-guided sampling of solid lesions: a systemic review and meta-analysis. Endoscopy 2021;53:411-423. 
  8. Facciorusso A, Sunny SP, Del Prete V, et al. Comparison between fine-needle biopsy and fine-needle aspiration for EUS-guided sampling of subepithelial lesions: a meta-analysis. Gastrointest Endosc 2020;91:14-22. 
  9. Zhang XC, Li QL, Yu YF, et al. Diagnostic efficacy of endoscopic ultrasound-guided needle sampling for upper gastrointestinal subepithelial lesions: a meta-analysis. Surg Endosc 2016;30:2431-2441. 
  10. Yokohata N, Tamegai Y, Tokuhara M, et al. 3 case of gastric SMT (submucal tumor) which was diagnoced before operation: open biopsy with ESD (endoscopic submucal dissection) for interstind SMT. Prog Dig Endosc 2007;70:82-83. 
  11. Ihara E, Matsuzaka H, Honda K, et al. Mucosal-incision assisted biopsy for suspected gastric gastrointestinal stromal tumors. World J Gastrointest Endosc 2013;5:191-196. 
  12. Dhaliwal A, Kolli S, Dhindsa BS, et al. Clinical efficacy and safety of mucosal incision-assisted biopsy for the diagnosis of upper gastrointestinal subepithelial tumors: a systematic review and meta-analysis. Ann Gastroenterol 2020;33:155-161. 
  13. Dhaliwal A, Kolli S, Dhindsa BS, et al. Diagnostic yield of deep biopsy via endoscopic submucosal dissection for the diagnosis of upper gastrointestinal subepithelial tumors: a systematic review and meta-analysis. Ann Gastroenterol 2020;33:30-37. 
  14. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. 
  15. Higgins JP, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928. 
  16. Sterne JA, Hernan MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016;355:i4919. 
  17. Jung YS, Lee H, Kim K, et al. Using forceps biopsy after small submucosal dissection in the diagnosis of gastric subepithelial tumors. J Korean Med Sci 2016;31:1768-1774. 
  18. Kobara H, Mori H, Nishimoto N, et al. Comparison of submucosal tunneling biopsy versus EUS-guided FNA for gastric subepithelial lesions: a prospective study with crossover design. Endosc Int Open 2017;5:E695-E705. 
  19. Osoegawa T, Minoda Y, Ihara E, et al. Mucosal incision-assisted biopsy versus endoscopic ultrasound-guided fine-needle aspiration with a rapid on-site evaluation for gastric subepithelial lesions: a randomized cross-over study. Dig Endosc 2019;31:413-421. 
  20. Park J, Park JC, Jo JH, et al. Prospective comparative study of endoscopic ultrasonography-guided fine-needle biopsy and unroofing biopsy. Dig Liver Dis 2019;51:831-836. 
  21. Minoda Y, Chinen T, Osoegawa T, et al. Superiority of mucosal incision-assisted biopsy over ultrasound-guided fine needle aspiration biopsy in diagnosing small gastric subepithelial lesions: a propensity score matching analysis. BMC Gastroenterol 2020;20:19. 
  22. Zoundjiekpon V, Falt P, Fojtik P, et al. Endosonography-guided fine-needle aspiration versus "Key-Hole Biopsy" in the diagnostics of upper gastrointestinal subepithelial tumors: a prospective randomized interventional study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020;164:63-70. 
  23. Sanaei O, Fernandez-Esparrach G, De La Serna-Higuera C, et al. EUS-guided 22-gauge fine needle biopsy versus single-incision with needle knife for the diagnosis of upper gastrointestinal subepithelial lesions: a randomized controlled trial. Endosc Int Open 2020;8:E266-E273. 
  24. Deprez PH, Moons LM, O'Toole D, et al. Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022;54:412-429. 
  25. Casali PG, Blay JY, Abecassis N, et al. Gastrointestinal stromal tumours: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2022;33:20-33. 
  26. Nishida T, Hirota S, Yanagisawa A, et al. Clinical practice guidelines for gastrointestinal stromal tumor (GIST) in Japan: English version. Int J Clin Oncol 2008;13:416-430. 
  27. Kim HH. Endoscopic treatment for gastrointestinal stromal tumor: advantages and hurdles. World J Gastrointest Endosc 2015;7:192-205. 
  28. Facciorusso A, Crino SF, Ramai D, et al. Comparison between endoscopic ultrasound-guided fine-needle biopsy and bite-on-bite jumbo biopsy for sampling of subepithelial lesions. Dig Liver Dis 2022;54:676-683. 
  29. Larghi A, Fuccio L, Chiarello G, et al. Fine-needle tissue acquisition from subepithelial lesions using a forward-viewing linear echoendoscope. Endoscopy 2014;46:39-45. 
  30. Matsuzaki I, Miyahara R, Hirooka Y, et al. Forward-viewing versus oblique-viewing echoendoscopes in the diagnosis of upper GI subepithelial lesions with EUS-guided FNA: a prospective, randomized, crossover study. Gastrointest Endosc 2015;82:287-295.