Post written by Masahiro Itonaga, MD, and Masayuki Kitano, MD, PhD, from the Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan.

To the best of our knowledge, no large multicenter randomized controlled trials (RCTs) have compared EUS-guided tissue acquisition (EUS-TA) using standard needles and Franseen needles for the diagnosis of solid pancreatic lesions. Therefore, the aim of the present large multicenter RCT was to compare the diagnostic yields of EUS-TA of solid pancreatic lesions using 22-gauge standard needles and 22-gauge Franseen needles.

A total of 523 patients were randomized to EUS-TA using 22-gauge standard needles (n = 260) or 22-gauge Franseen needles (n = 263). The technical success rate in each group was 99.6%, with similar adverse event rates in the standard (1.5%) and Franseen (0.8%) needle groups.

First-pass EUS-TA using a Franseen needle resulted in significantly greater diagnostic accuracy (84.0% vs 71.2%, P < .001) and sensitivity (82.4% vs 66.7%, P < .001) than first-pass EUS-TA using a standard needle and resulted in superior diagnostic accuracy in patients requiring immunostaining.

Second and subsequent EUS-TA using Franseen needles showed significantly greater accuracy (94.7% vs 90.0%, P = .049) and sensitivity (94.0% vs 88.6%, P =.047) and required fewer needle passes (1.81 vs 2.03, P = .008) than using standard needles.

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