The University of Toledo Translation Journal of Medical Sciences 
Gastroenterology Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e2 

EUS Guided Through the Needle Biopsy 
Versus Fine Needle Aspiration for 
Pancreatic Cystic Lesions: A Systemic 
Review and Meta-analysis. 

Wasef Sayeh, MD 1*, Azizullah Beran, MD1, Sami Ghazaleh, MD2, Mohammad Safi; 
MD1, David Farrow, MD1, Sudheer Dhoop, MD1, Justin Chaung, MD1, Saif-Eddin 
Malhas, MD1, Waleed Khokher, MD1, Omar Sajdeya, MD1, Anas Renno, MD2, 
Muhammad Aziz, MD2, Yaseen Alastal; MD2

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 
2Division of Gastroenterology and Hepatology, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 

*Corresponding author: wasef.sayeh@utoledo.edu

Published: 05 May 2023 

Introduction: EUS guided FNA has been widely used to collect samples from pancreatic cystic lesions 
(PCLs) for cytology and fluid analysis. However, EUS guided FNA has relatively lower sensitivity in 
discriminating the types of lesions. Recent studies have investigated the EUS guided through the needle 
biopsy (EUS-TTNB) as an alternative method. 

Methods: We performed a comprehensive search of the databases: PubMed/MEDLINE, Embase, and 
the Cochrane Central Register of Controlled Trials from inception through May 10th, 2022. We 
considered randomized controlled trials, cohort studies, and case-control studies. The primary outcome 
was sample adequacy which is defined as the presence of enough sample for histopathological 
evaluation. The secondary outcome was sample accuracy which is defined as the ability to have a 
definite diagnosis. The random-effects model was used to calculate the risk ratios (RR) and confidence 
intervals (CI). A p value <0.05 was considered statistically significant.  

Results: Nine observational studies involving 520 patients were included in the meta-analysis. The rate 
of sample adequacy was significantly higher in the EUS-TTNB group (RR 1.64, 95% CI 1.19-2.26, p 
=0.003, I2 = 95%) (Figure 1a). The diagnostic accuracy was significantly higher in the same group (RR 
2.03, 95% CI 1.13-3.65, p = 0.02, I2 = 87%) (Figure 1 b).  

Discussion: Our meta-analysis demonstrated that the rates of both sample adequacy and accuracy were 
higher in the EUS-TTNB group compared to the EUS-FNA group. EUS-TTNB should be considered 

https://dx.doi.org/10.46570/utjms.vol11-2023-678 

https://dx.doi.org/10.46570/utjms.vol11-2023-678
mailto:wasef.sayeh@utoledo.edu


https://dx.doi.org/10.46570/utjms.vol11-2023-678 UTJMS 11(1):e1-e2 

https://dx.doi.org/10.46570/utjms.vol11-2023-678 2 ©2023 UTJMS 

where applicable clinically for improving the diagnostic yield in patients undergoing evaluation of 
PCLs. 

https://dx.doi.org/10.46570/utjms.vol11-2023-678
https://dx.doi.org/10.46570/utjms.vol11-2023-678